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Bureau of Primary Health Care
UNIFORM DATA SYSTEM (UDS)
Calendar Year 2010
UDS Reporting Instructions for
Section 330 Grantees
For help contact: 866-837-4357 (866-UDS-HELP) or [email protected]
BUREAU OF PRIMARY HEALTH CARE
1
DRAFT
BPHC UNIFORM DATA SYSTEM MANUAL
For use to submit Calendar Year 2010 UDS Data
U.S. Department of Health and Human Services
Health Resources and Services Administration
BUREAU OF PRIMARY HEALTH CARE
5600 FISHERS LANE, Room 15C-26, ROCKVILLE, MARYLAND 20857
October xx, 2010
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DRAFT
OMB Control Number 0195-0193
Expiration date 01/31/2011
2010 UNIFORM DATA SYSTEM MANUAL
CONTENTS
SECTION
PAGE
INTRODUCTION....................................................................................................................3
GENERAL INSTRUCTIONS ..................................................................................................5
DEFINITIONS OF VISITS, PROVIDERS, PATIENTS AND FTES .........................................6
INSTRUCTIONS BY TABLE ................................................................................................12
INSTRUCTIONS for ZIP CODE DATA.................................................................................14
INSTRUCTIONS FOR TABLES 3A AND 3B – PATIENTS BY AGE AND GENDER AND
PATIENTS BY HISPANIC or LATINO IDENTITY / RACE / LANGUAGE .............................17
INSTRUCTIONS FOR TABLE 4 – SELECTED PATIENT CHARACTERISTICS .................23
INSTRUCTIONS FOR TABLE 5 – STAFFING AND UTILIZATION .....................................31
INSTRUCTIONS FOR TABLE 6A - SELECTED DIAGNOSES AND SERVICES
RENDERED .........................................................................................................................40
INSTRUCTIONS FOR TABLE 6B – QUALITY OF CARE INDICATORS .............................48
INSTRUCTIONS FOR TABLE 7 – HEALTH OUTCOMES AND DISPARITIES ...................59
INSTRUCTIONS FOR TABLE 8A - FINANCIAL COSTS .....................................................68
INSTRUCTIONS FOR TABLE 9D - PATIENT- RELATED REVENUE.................................76
INSTRUCTIONS FOR TABLE 9E - OTHER REVENUE ......................................................84
APPENDIX A: LISTING OF PERSONNEL..........................................................................89
APPENDIX B: SPECIAL MULTI-TABLE SITUATIONS .......................................................94
APPENDIX C: SAMPLING METHODODOLOGY FOR MANUAL CHART REVIEWS ......106
NOTE: TABLES 1, 2, 8B, 9A, 9B, AND 9C WHICH WERE INCLUDED IN EARLIER VERSIONS OF
THE UDS, HAVE BEEN DELETED.
PUBLIC BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average 62 hours per response, including the time for
reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.
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INTRODUCTION
DRAFT
This is the 15th edition of the Bureau of Primary Health Care’s User’s Manual: Uniform Data System It
is designed for use in submitting Calendar Year 2010 UDS Data, and updates all instructions and
modifications issued since the first UDS reporting year (1996). This Manual supersedes all previous
manuals, including instructions provided on the BPHC Web site prior to October 2010.
The Manual includes a brief introduction to the Uniform Data System, definitions of terms as they are
used in the UDS, instructions for completing each of the tables, and information on submission of UDS
to the BPHC through its Electronic Hand Book (EHB) system. . Table-specific instructions also
include a set of “Questions and Answers,” addressing issues that are frequently raised when
completing the tables and highlighting changes to the table that may have been implemented during
the year. Three appendices are included which: (A) list personnel by category and designation of
personnel as providers who can produce countable “visits” for the purpose of the UDS; (B) describe
how to report issues which have impact on multiple tables; and (C) provide sampling methodologies
for selecting charts for clinical reviews.
The UDS is an integrated reporting system used by all grantees of the following primary care
programs administered by the Bureau of Primary Health Care (BPHC), Health Resources and
Services Administration:
-
Community Health Center, as defined in Section 330(e) of the Consolidated Health Centers
Act as amended;
Migrant Health Center, as defined in Section 330(g) of the Act;
Health Care for the Homeless, as defined in Section 330(h) of the Act;
Public Housing Primary Care, as defined in Section 330(i) of the Act.
ARRA funded activities are also reported in the UDS, since activities (patients, visits, income and
expenses) which have been and/or are being supported by one or more element of the American
Recovery and Reinvestment Act (ARRA) are integrated with other Section 330 funded activities.,
BPHC collects data on its programs to ensure compliance with legislative mandates and to report to
Congress, OMB, and other policy makers on program accomplishments. To meet these objectives,
BPHC requires that grantees submit a core set of information annually that is appropriate for reviewing
and evaluating performance and for reporting on annual trends. The UDS is the vehicle used by
BPHC to obtain this information. (Note: Grantees are also required to report ARRA funded activities
to BPHC in a separate Health Center Quarterly Report (HCQR). These instructions are included in a
separate HCQR Reporting Manual available on the BPHC web site and are not addressed in this
manual).
The UDS includes two components:
- The Universal Report, completed by all grantees. The Universal Report consists of one copy
of each of the UDS reporting tables. This report provides data on patients, services, staffing,
and financing across all programs. The Universal Report is the source of unduplicated data
on BPHC programs.
-
The Grant Reports, completed by a sub-set of grantees who receive multiple grants from
the BPHC health center program. The Grant Report consists of additional copies of only
Tables 3A, 3B, 4, 6A and part of Table 5. The Grant reports provide comparable data for that
portion of their program that falls within the scope of a project funded under a particular
grant. Separate Grant Reports are required for Migrant Health Center, Health Care for the
Homeless, and Public Housing Primary Care grantees unless a grantee is funded under one
and only one of these programs. No Grant Report is submitted for the portion of multi-funded
grantee’s activities supported by the Community Health Center grant.
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The UDS is composed of 11 tables intended to yield consistent clinical, operational and financial data
that can be compared with other National and State data and trended over time. These tables are:
DRAFT
-
Patient Origin form: Patients served by zip code.
Table 3A: Patients by age and gender.
Table 3B: Patients by race, ethnicity and language.
Table 4: Patients by income (% of poverty level) and third party medical insurance source.
It also reports the number of special population patients receiving services.
Table 5: Reports full-time equivalent staff by position; and visits and patients by provider
type and service type.
Table 6A: Primary diagnoses for medical and mental health visits and selected medical
and dental services provided.
Table 6B: Quality of care indicators.
Table 7: Health outcomes and health disparities.
Table 8: Direct and indirect expenses by cost center.
Table 9D: Full charges, collections and allowances by payor as well as sliding discounts
and patient bad debt.
Table 9E: Non patient-service income.
The UDS report is always a calendar year report. Agencies whose funding begins, either in whole or
in part, after the beginning of the year, or whose funding is terminated, again either in whole or in part,
before the end of the year, are still required to report on the entire year to the best of their ability.
Since 2006 persons served by BPHC-supported clinics are referred to in this manual as “patients.”
Inconsistent language, referring to such persons as “clients”, or “users” has led to some confusion in
the past. There is no intent to change the individuals who are being counted or reported on in the
UDS process. All persons previously referred to and counted under any of these terms will continue to
be counted in the UDS.
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GENERAL INSTRUCTIONS
DRAFT
This section describes submission requirements including who submits UDS reports, when and where
to submit UDS data, and how data are submitted.
WHO SUBMITS REPORTS AND REPORTING PERIODS
Reports should be submitted directly by the BPHC grantee. A grantee is the direct recipient of one or
more BPHC grants. All grantees that were funded before October 1, 2010 are expected to report.
Grantees must report activity for the entire calendar year, even if they were funded, in whole or in part,
for less than the full year, even if they did not draw down any grant funds in the year. Grantees who
are funded for the first time after October 1, 2010 and who received no other funds from BPHC during
the year are not required to submit a 2010 UDS report.
DUE DATES AND REVISIONS TO REPORTS
UDS Reports are initially due by February 15, 2011. Between February 15th and March 31st grantees
work with BPHC’s contractor to identify and correct possible errors. Final submission is due by
March 31st and changes after this date are not accepted. To request assistance, please contact
the UDS helpline at 1-866-UDS-HELP.
HOW AND WHERE TO SUBMIT DATA
Starting with the CY 2008 UDS submission, reporting has been on-line making use of a web based
data collection system that is completely integrated with the HRSA Electronic Handbooks (EHBs).
Health Center users will use their EHB user name and password to log into the EHB in order to
complete their UDS submission. Users will be able to submit the UDS report data using standard web
browsers 1 through a Section 508 compliant user interface. The system will present users with
electronic forms that will guide them in completing their reports.
Users will be able to work on the forms in sections, saving them online as they work, and return to
complete them later as needed. This permits grantees to distribute the data entry responsibilities
amongst multiple users if required. Note, however, that health center staff must be assigned either
“view” or “edit” privileges for the entire UDS, not just specific tables. Automated edits will check for
questionable quantitative and qualitative data to ensure that the data submitted are as accurate as
possible.
The EHB will provide users with a summary of which tables are complete.
1
While most popular browsers should work with the EHB, it is certified to work with Internet Explorer Version 7
or higher. Grantees having a problem with other browsers should consider using IE-7 for this task.
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DEFINITIONS OF VISITS, PROVIDERS, PATIENTS AND FTES
DRAFT
This section provides definitions which are critical for consistent reporting of UDS data across
grantees.
VISITS
Visit definitions are needed both to determine who is counted as a patient (Tables 3A, 3B, 4, 6A, 6B
and 7) and to report visits by type of provider staff (Table 5) and visits where selected diagnoses were
made or where selected services were provided (Table 6A). Visits are defined as documented,
face-to-face contacts between a patient and a provider who exercises independent
professional judgment in the provision of services to the patient. To be included as a visit,
services rendered must be documented in a chart in the possession of the grantee. Appendix A
provides a list of health center personnel and the usual status of each as a provider or non-provider for
purposes of UDS reporting. Visits which are provided by contractors, and paid for by the grantee,
such as Migrant Voucher visits or out-patient or in-patient specialty care associated with an at-risk
managed care contract, are considered to be visits to be counted on the UDS to the extent that they
meet all other criteria. In these instances, a summary of the visit may appear in the grantee’s charts.
Further elaborations of the definitions and criteria for defining and reporting visits are included below.
1. To meet the criterion for "independent professional judgment," the provider must be acting
on his/her own when serving the patient and not assisting another provider. For example, a
nurse assisting a physician during a physical examination by taking vital signs, taking a history
or drawing a blood sample is not credited with a separate visit. Independent judgment implies
the use of the professional skills associated with the profession of the individual being credited
with the visit and unique to that provider or other similarly or more intensively trained providers.
Eligible visits usually involve one of the “Evaluation and Management” billing codes (99281-85,
99291-95) or one of the health maintenance codes (99381-87, 99391-97).
2. To meet the criterion for "documentation," the service (and associated patient information)
must be recorded in written or electronic form. The patient record does not have to be a full
and complete health record in order to meet this criterion. For example, if an individual
receives services on an emergency basis and these services are documented, the
documentation criterion is met even though some portions of the health record are not
completed. A provider who sees their patient at a hospital or nursing home and makes a note
in the institutional file can satisfy this criteria by including a summary note from the hospital or
nursing home indicating activities for each of the dates for which a visit is claimed. Screenings
such as those frequently conducted at health fairs, immunization drives for children or the
elderly, and similar public health efforts do not result in visits regardless of the level of
documentation.
3. When a behavioral health provider (i.e., a mental health or substance abuse provider) renders
services to several patients simultaneously, the provider can be credited with a visit for each
person only if the provision of service is noted in each person's health record. Such visits are
limited to behavioral health services. Examples of such non-medical "group visits" include:
family therapy or counseling sessions and group mental health counseling during which
several people receive services and the services are noted in each person's health record. In
such situations, each patient is normally billed for the service. Medical visits must be provided
on an individual basis. Patient education or health education classes (e.g., smoking cessation)
are not credited as visits.
4. A visit may take place in the health center or at any other approved site or location in which
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project-supported activities are carried out. Examples of other sites and locations include
mobile vans, hospitals, patients' homes, schools, nursing homes, homeless shelters, and
extended care facilities. (If visits at these sites occur on a regularly scheduled basis the site
must be an approved site within the scope of the agency’s grant.) Visits also include contacts
with patients who are hospitalized, where health center medical staff member(s) follow the
patient during the hospital stay as physician of record or where they provide consultation to the
physician of record provided they are being paid by the grantee for these services and the
patient is billed either for the specific service or through a global fee. A reporting entity may
not count more than one inpatient visit per patient per day regardless of how many clinic
providers see the patient or how often they do so.
DRAFT
5. Such services as drawing blood, collecting urine specimens, performing laboratory tests
(including pregnancy tests and PPDs), taking X-rays, giving immunizations or other injections,
and filling/dispensing prescriptions do not constitute visits, regardless of the level or quantity of
supportive services.
6. Under certain circumstances a patient may have more than one visit with the health center in a
day. The number of visits per service delivery location per day is limited as follows. On any
given day a patient may have, at a maximum:
- One medical visit (physician, nurse practitioner, physicians assistant, certified nurse
midwife, or nurse).
- One dental visit (dentist or hygienist).
- One “other health” visit for each type of “other health” provider (nutritionist, podiatrist,
speech therapist, acupuncturist, optometrist, etc.).
- One “vision services” visit (Ophthalmologist, Optometrist)
- One enabling service visit for each type of enabling provider (case management or health
education).
- One mental health visit.
- One substance abuse visit.
If multiple medical providers deliver multiple services on a single day (e.g., an Ob-Gyn provides
prenatal care and in Internist treats hypertension) only one of these visits may be counted on
the UDS. While some third party payors may recognize these as billable, only one of them is
countable. The decision as to which provider gets credit for the visit on the UDS is up to the
grantee. Internally, the grantee may follow any protocol it wishes in terms of crediting
providers with visits.
An exception to this rule, designed to address the operational structure of homeless and
migrant programs, allows medical services provided by two different medical providers located
at two different sites to be counted on the same day. This permits patients who are seen in
clinically problematic environments (e.g., homeless shelters or migrant camps), especially by
non-physician providers, to be seen later in the same day at the grantee’s fixed clinic site by a
different provider.
7. A provider may be credited with no more than one visit with a given patient in a single day,
regardless of the types or number of services provided.
8. The visit criteria are not met in the following circumstances:
- When a provider participates in a community meeting or group session that is not designed
to provide clinical services. Examples of such activities include information sessions for
prospective patients, health presentations to community groups (high school classes, PTA,
etc.), and information presentations about available health services at the center.
- When the only health service provided is part of a large-scale effort, such as a mass
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immunization program, screening program, or community-wide service program (e.g., a
health fair).
When a provider is primarily conducting outreach and/or group education sessions, not
providing direct services.
When the only services provided are lab tests, x-rays, immunizations or other injections,
TB tests or readings and/or prescription refills.
Services performed under the auspices of a WIC program or a WIC contract.
DRAFT
-
Further definitions of visits for different provider types follow:
PHYSICIAN VISIT – A visit between a physician and a patient.
NURSE PRACTITIONER VISIT – A visit between a Nurse Practitioner and a patient in which the
practitioner acts as an independent provider.
PHYSICIAN ASSISTANT VISIT – A visit between a Physician Assistant and a patient in which the
practitioner acts as an independent provider.
CERTIFIED NURSE MIDWIFE VISIT – A visit between a Certified Nurse Midwife and a patient in which
the practitioner acts as an independent provider.
NURSE VISIT (Medical) – A visit between an R.N., L.V.N. or L.P.N. and a patient in which the nurse
acts as an independent provider of medical services exercising independent judgment, such as in
a triage visit. Services which meet this criteria may be provided under standing orders of a
physician, under specific instructions from a previous visit, or under the general supervision of a
physician, Nurse Practitioner, Physicians Assistant, or Certified Nurse Midwife (NP/PA/CNM) who
has no direct contact with the patient during the visit, but must still meet the requirement of
exercising independent professional judgment. (Note that some states prohibit an LVN or an LPN
from exercising independent judgment, in which case no visits would be counted for them. Note
also that, under no circumstances are services provided by Medical Assistants or other nonnursing personnel counted as nursing visits.)
DENTAL SERVICES VISIT – A visit between a dentist or dental hygienist and a patient for the
purpose of prevention, assessment, or treatment of a dental problem, including restoration. NOTE:
A dental hygienist is credited with a visit only when s/he provides a service independently, not
jointly with a dentist. Two visits may not be generated during a patient's visit to the dental clinic in
one day, regardless of the number of clinicians who provide independent services or the volume of
service (number of procedures) provided.
MENTAL HEALTH VISIT – A visit between a licensed mental health provider (psychiatrist,
psychologist, LCSW, and certain other Masters Prepared mental health providers licensed by
specific states,) or an unlicensed mental health provider credentialed by the center, and a patient,
during which mental health services (i.e., services of a psychiatric, psychological, psychosocial, or
crisis intervention nature) are provided. (Note: The term “behavioral health” is synonymous with
the prevention or treatment of mental health and substance abuse disorders. All behavioral health
visits, providers and costs must be parsed out into mental health or substance abuse.)
SUBSTANCE ABUSE VISITS – A visit between a substance abuse provider (e.g., a mental health
provider or a credentialed substance abuse counselor, rehabilitation therapist, psychologist) and a
patient during which alcohol or drug abuse services (i.e., assessment and diagnosis, treatment, or
aftercare) are provided. (Note: The term “behavioral health” is synonymous with the prevention or
treatment of mental health and substance abuse disorders. All behavioral health visits, providers
and costs must be parsed out into mental health or substance abuse.)
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VISION SERVICES VISIT – A visit between a vision service provider and a patient during which eye
exams are performed by an Ophthalmologist or an Optometrist for the purpose of early detection,
care, treatment and prevention of those who suffer from eye disease and chronic diseases such as
diabetes, hypertension, thyroid disease and arthritis. These exams also provide opportunities to
promote behavioral changes linked to eye health (e.g., smoking, excessive use of alcohol.)
DRAFT
OTHER PROFESSIONAL VISIT – A visit between a provider, other than those listed above and a patient
during which other forms of health services are provided. Examples are provided in Appendix A.
CASE MANAGEMENT VISIT – A visit between a case management provider and a patient during
which services are provided that assist patients in the management of their health and social
needs, including patient needs assessments, the establishment of service plans, and the
maintenance of referral, tracking, and follow-up systems. These must be face to face with the
patient. Third party interactions on behalf of a patient are not counted as case management visits.
HEALTH EDUCATION VISIT – A one-on-one visit between a health education provider and a patient
in which the services rendered are of an educational nature relating to health matters and
appropriate use of health services (e.g., family planning, HIV, nutrition, parenting, or specific
diseases). Participants in health education classes are not considered to have had visits.
PROVIDER
A provider is the individual who assumes primary responsibility for assessing the patient and
documenting services in the patient's record. Providers include only individuals who exercise
independent judgment as to the services rendered to the patient during a visit. Only one provider who
exercises independent judgment is credited with the visit, even when two or more providers are
present and participate. If two or more providers of the same type divide up the services for a patient
(e.g., a family practitioner and a pediatrician both seeing a child) only one may be credited with a visit .
Where health center staff are following a patient in the hospital, the primary responsible center staff
person in attendance during the visit is the provider (and is credited with a visit ), even if other staff
from the health center and/or hospital are present. (Appendix A provides a listing of personnel. Only
personnel designated as a “provider” can generate visits for purposes of UDS reporting.)
Providers may be employees of the health center, contracted staff, or volunteers. Contract providers
who are part of the scope of the approved grant-funded program and who are paid by the center with
grant funds or program income, serve center patients and document their services in the center's
records, are considered providers. (A discharge summary or similar document in the medical record
will meet this criteria.) Also, contract providers paid for specific visits or services with grant funds or
program income, who report patient visits to the direct recipient of a BPHC grant (e.g., under a migrant
voucher program or contractors with homeless grantees) are considered providers and their activities
are to be reported by the direct recipient of the BPHC grant. Since there is no time basis in their
report, no FTE is reported for such individuals. Volunteer providers who serve center patients at the
grantee’s sites or locations under the supervision of the center’s staff and document their services in
the center's records are also considered providers. Their time is known and should be documented.
PATIENT
Patients are individuals who have at least one reportable visit during the reporting year 2 , as
defined above. The term “patient” is not limited to recipients of medical or dental services; the term is
2
Certain other reporting systems including BPHC’s HCQR report for the ARRA program use a different
definition of a patient. Patients should be counted in both reports, according to the definitions for each report.
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used universally to describe all persons provided UDS-countable visits.
DRAFT
The Universal Report includes all patients who have at least one visit during the year within the
scope of activities supported by any BPHC grant covered by the UDS and reported on Table 5. On
tables 3A, 3B, 4 and 6A of the Universal Report, each patient is counted once and only once, even if
s/he received more than one type of service (e.g. medical, dental, enabling, etc.) or receives services
supported by more than one BPHC grant. For each Grant Report, patients reported are those who
have at least one visit during the year within the scope of project activities supported by the specific
BPHC grant. A patient counted in any cell on a Grant Report is also included in the same cell on the
Universal Report.
Persons who only receive services from large-scale efforts such as immunization programs, screening
programs, and health fairs are not counted as patients. Persons whose only service from the grantee
is a part of the WIC program or other programs are not counted as patients.
Centers see many individuals who do not become patients as defined by and counted in the UDS
process. “Patients,” as defined for the UDS, never include individuals who have such limited contacts
with the grantee, whether or not documented on an individual basis. These include, but are not limited
to, persons whose only contact is:
-
-
When a provider participates in a community meeting or group session that is not designed
to provide clinical services. Examples of such activities include information sessions for
prospective patients, health presentations to community groups (high school classes, PTA,
etc.), and information presentations about available health services at the center.
When the only health service provided is part of a large-scale effort, such as an
immunization program, screening program, or community-wide service program (e.g., a
health fair).
When a provider is primarily conducting outreach and/or group education sessions, not
providing direct services.
When the only services provided are lab tests, x-rays, immunizations or other injections,
TB tests or readings, and/or filling or refilling a prescription.
Services performed under the auspices of a WIC program or a WIC contract.
FULL-TIME EQUIVALENT EMPLOYEE
A full-time equivalent (FTE) of 1.0 describes staff who individually or as a group worked the equivalent
of full-time for one year. Each agency defines the number of hours for “full-time” work. For example, if
a physician is hired full-time and works 36 hours per week, she is a 1.0 FTE. The full-time equivalent
is based on employment contracts for clinicians and exempt employees; FTE is calculated based on
paid hours for non-exempt employees. FTEs are adjusted for part-time work or for part-year
employment. In an organization that has a 40 hour work week (2080 hours/year), a person who
works 20 hours per week (i.e., 50% time) is reported as “0.5 FTE.” In some organizations different
positions have different time expectations. Positions with different time expectations, especially
clinicians, should be calculated on whatever they have as a base for that position. Thus, if physicians
work 36 hours per week, this would be considered 1.0 FTE, and an 18 hour per week physician would
be considered as 0.5 FTE, regardless of whether other employees work 40 hours weeks. FTE is also
based on the part of the year that the employee works. An employee who works full time for four
months out of the year would be reported as “0.33 FTE” (4 months/12 months).
Staff may provide services on behalf of the grantee under many different arrangements including, but
not limited to: salaried full-time, salaried part-time, hourly wages, National Health Service Corps
assignment, under contract, or donated time. Interns, residents and volunteers are counted consistent
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with their time with the grantee and their licensing. (See Appendix B for further discussion.)
Individuals who are paid by the grantee on a fee-for-service basis only and do not have specific
assigned hours, are not counted in the calculation of FTEs since there is no basis for determining their
hours.
DRAFT
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INSTRUCTIONS BY TABLE
DRAFT
This section provides an overview of the UDS report and detailed instructions for completing each
UDS table.
OVERVIEW OF UDS REPORT
The UDS includes two components:
•
The Universal Report is completed by all grantees. This report provides data on services,
staffing, and financing across all programs. The Universal Report is the source of
unduplicated data on BPHC programs.
•
Grant Reports are completed by a sub-set of grantees who receive BPHC grants under
multiple program authorizations. These reports repeat all or part of the elements of five of
the Universal Report tables. Grant reports provide comparable data for that portion of their
program that falls within the scope of a project funded through a specific funding authority.
Separate Grant Reports are required for Migrant Health Center, Homeless Health Care, and
Public Housing Primary Care grantees except for grantees funded under one and only one of
these programs which receive no other BPHC funding. No Grant Report is submitted for the
portion of a grantee’s activities supported by the Community Health Center grant.
The Universal Report provides a comprehensive picture of all activities within the scope of BPHCsupported projects. In this report, grantees should report on the total unduplicated number of patients
and activities for the reporting year which are within the scope of projects supported by any and
all BPHC primary care programs covered by the UDS including those supported by the ARRA
program and reported separately in Health Center Quarterly Reports (HCQRs).
For Grant Reports, grantees provide data on the patients and activities within that part of their
program which is funded under a particular program. Because a patient can receive services
through more than one of BPHC program, and not all grants are reported separately, totals from the
Grant Reports cannot be aggregated to generate totals in the Universal Report.
Grantees that receive funds under only one BPHC funding authority are required to complete
only the Universal Report and do not submit grant reports. Agencies funded through multiple
BPHC funding authorities, complete a Universal Report for the combined projects and a
separate grant report for each Migrant, Homeless, and/or Public Housing program grant.
Examples include the following:
•
•
•
A CHC grantee (Section 330e) that also has Health Care for the Homeless support (Section
330h) completes a Universal Report and a Homeless Grant Report, but does not complete a
Grant Report for the CHC grant.
A CHC grantee (Section 330e) that also has Migrant Health (Section 330g) and Homeless
(Section 330h) support, completes a Universal Report, a Grant Report for the Homeless
program, and a Grant Report for the Migrant program.
A grantee which is funded under the Health Care for the Homeless program and the Public
Housing program completes a Universal Report and two Grant Reports – one for Homeless
and one for Public Housing.
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NOTE: The EHB reporting system will automatically identify the reports which must be filed
and prompt the grantee if some or all of the Universal or Grant Report is left blank.
DRAFT
The table below indicates which tables are included in the Universal Report and Grant Reports. Also
listed are tables that have been deleted from the UDS since the system was initiated in 1996. No
further reference to any of the deleted tables is made in this Manual.
TABLE
UNIVERSAL
REPORT
Grantee Profile
Patients by zip code
X
Cover Sheet
NO LONGER REPORTED
Table 2
NO LONGER REPORTED
GRANT
REPORTS
SERVICE AREA
PATIENT PROFILE
Table 3A
Patients by Age and Gender
X
X
Table 3B
Patients by Hispanic/Latino Identity
and Race; Patients best served in a
language other than English
X
X
Table 4
Selected Patient Characteristics
X
X
Staffing and Utilization
X
Table 6A
Selected Diagnoses and Services
X
X
Table 6B
Quality of Care Indicators
X
Table 7
Health Outcomes and Disparities
X
Table 8A
Costs
X
Table 8B
NO LONGER REPORTED
Table 9(A-B-C)
NO LONGER REPORTED
Table 9(D-E)
Revenues
STAFFING AND UTILIZATION
Table 5
CLINICAL
FINANCIAL
October xx, 2010
X
13 1
INSTRUCTIONS FOR ZIP CODE DATA
DRAFT
PATIENT BY ZIP CODE:
Grantees must report the number of patients served by zip code. This information enables
BPHC to better identify areas served by health centers as well as minimize problems arising as
a result of service area overlaps.
It is the BPHC’s goal to identify residence by zip code for all patients served, but it is
understood that residence information may be missing for a small number of patients. This is
particularly true for centers that serve transient groups. Special instructions cover two of these
groups:
•
Homeless Patients: While many homeless patients live in shelters, transitional
housing, and other locations for which a zip code can be obtained, others –
especially those living on the street -- do not know or will not share an exact
location. Where a zip code location cannot be obtained or the location offered is
questionable, grantees should use the zip code of the location where the patient is
being served as a proxy. Similarly, if the patient has no other zip code and receives
services on a mobile van, the zip code of the location where the van was parked
that day should be used.
•
Migrant Patients: Many if not most Migrant Farm Workers have a permanent
residence in a community far from the location of their work and the site where they
are receiving services. For the purpose of the UDS report, grantees are to use the
zip code of the patient's temporary housing location near the service delivery
location. Patients living in cars or on the land where a precise zip code is
unavailable should be reported using the zip code for the location (fixed site or
mobile camp outreach) where they are being treated.
For the small number of patients for whom residence is not known or for whom a proxy is not
available, residence should be reported as “Unknown”.
Although grantees are expected to report residence by zip code for all patients, it is recognized
that large centers, as well as those located in tourist or hunting/fishing locations, may draw a
small number of patients from a large number of zip codes. To ease the burden of reporting,
zip codes with less than ten patients should be aggregated and reported in an “Other”
category.
October xx, 2010
14 1
QUESTIONS AND ANSWERS FOR ZIP CODE REPORTING
DRAFT
1. Are there any changes to this table?
No.
2. Do we need to collect information on and report on the zip code of all of our patients?
Yes. Instead of asking that individual sites be identified by area served, grantees are now asked
to report on the zip codes of their patients. Although grantees are expected to report residence by
zip-code for all patients, it is recognized that large centers may draw a small number of patients
from a large number of zip-codes. To ease the burden of reporting, zip codes with less than 10
patients should be aggregated and reported in an “Other” category.
3. Does the number of patients reported by zip code need to equal the total number of
unduplicated patients reported on Tables 3A, 3B and 4?
Yes. The total number of patients reported by zip code (including “unknown” and “other”) on the
Grantee Profile must equal the number of total unduplicated patients reported on Tables 3A, 3B
and 4. If zip code information is missing for some patients, residence should be reported as
unknown.
October xx, 2010
15 1
DRAFT
Patients By ZIP CODE
Zip Code
Patients
Other Zip Codes
Unknown Residence
TOTAL
Note: This is a representation of the form, however the actual on-line input process will look
significantly different, as may the printed output from the EHB.
October xx, 2010
16 1
INSTRUCTIONS FOR TABLE 3A– PATIENTS BY AGE AND GENDER AND
TABLE 3B PATIENTS BY RACE AND HISPANIC or LATINO IDENTITY /
LANGUAGE
DRAFT
Tables 3A and 3B provide demographic data on patients in the program and are included in both the
Universal Report and the Grant Reports. Note that patients supported through the ARRA programs
are included in this report to the extent that they qualify under all other UDS rules.
For the Universal Report, include as patients all individuals receiving at least one face-to-face visit for
services as described below which is within the scope of any of the programs covered by UDS.
Regardless of the scope or volume of services received, each patient is to be counted only once on
Table 3A and only once in each of the two sections of Table 3B: race and ethnicity, and language, if
applicable.
The Grant Reports include only individuals who received at least one face-to-face visit within the
scope of the program in question. As discussed above, patients are to be reported only once in each
report filed, however if the same patient is served in more than one program, they will be reported on
the grant report for each program that served them. All patients reported on the Grant Report will also
be reported on the Universal Report
A visit is a face-to-face contact between a patient and a provider who exercises independent
professional judgment in the provision of services to the patient, and the services rendered must be
documented to be counted as a visit. See the “Definitions of Visits, Providers, Patients, and FTE”
section (above page 6) for complete definitions.
TABLE 3A: PATIENTS BY AGE AND GENDER
Report the number of patients by appropriate categories for age and gender. For reporting purposes,
use the individual's age on June 30 of the reporting period. Note that on tables 6B and 7, age is
essentially defined as age on December 31st. The numbers on Table 3A will therefore not be the
same as those on Tables 6B and 7, though they will be reasonably close.
TABLE 3B: PATIENTS BY HISPANIC OR LATINO IDENTITY / RACE / LANGUAGE
Table 3B displays the race and ethnicity of the patient population in a matrix format. This permits the
racial identification of the Hispanic/Latino population. Race and ethnicity continue to be defined as in
the past:
HISPANIC/LATINO IDENTITY:
• This table collects information on whether or not patients consider themselves to be of
Hispanic/Latino identity regardless of their race.
o Column A (Hispanic/Latino): Report the number of persons of Cuban, Mexican,
Puerto Rican, South or Central American, or other Spanish culture or origin,
broken down by their racial identification and including those Hispanics/Latinos
born in the United States. Do not count persons from Brazil or Haiti whose
ethnicity is not tied to the Spanish language.
o Column B (Not Hispanic/Latino) Report the number of all other patients except
those for whom there is neither racial nor Hispanic/Latino identity data.
October xx, 2010
17 1
o
Column C (Unreported / Refused to Report): Only one cell is available in this
column. Report on line 7, column C only those patients who left the entire race
and Hispanic/Latino Identity part of the intake form totally blank.
DRAFT
•
Patients who self-report as Hispanic/Latino but do not separately select a race are
reported on line 7, column A as Hispanic/Latino whose race is unreported or refused to
report.
•
All patients must be classified in one of the racial categories (including “Unreported /
refused to report”). This includes individuals who also consider themselves to be
“Hispanic/Latino”. Patients who self-report race but do not separately indicate if they
are “Hispanic/”Latino" are reported on the appropriate race line, column B.
Patients once categorized as “Asian / Pacific Islanders” are now divided on the Race
table into three separate categories:
o Line 2a. Native Hawaiian – Persons having origins in any of the original
peoples of Hawaii.
o Line 2b. Other Pacific Islanders – Persons having origins in any of the original
peoples of Guam, Samoa, Palau, Truk, Yap, or other Pacific Islands in
Micronesia, Melanesia or Polynesia.
o Line 2. “Total Hawaiian / Pacific Islander”, must equal lines 2a+2b
o Line 1. Asian – Persons having origins in any of the original peoples of the Far
East, Southeast Asia, or the Indian subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
“American Indian”/Alaska Native (line 4) includes persons having origins in any of the
original peoples of North and South America (including Central America), and who
maintain tribal affiliation or community attachment.
“More than one race” (line 6). Use this line only if your system captures multiple races
(but not a race and an ethnicity) and the patient has chosen two or more races. This is
usually done with an intake form which lists the races and tells the patient to “check
one or more” or “check all that apply”.
RACE:
•
•
•
Note: Grantees are required to report race and ethnicity for all patients. Some grantees'
patient registration systems are configured to capture data for patients who were asked to
report race or ethnicity. Grantees who are unable to distinguish a White Hispanic/Latino
patient from a Black Hispanic/Latino patient (because their system only asks patients if they
are White, Black or Hispanic/Latino), are instructed to report these Hispanic/Latino patients on
line 7, column A, as "unreported" race but included in the count of those with Hispanic or
Latino identity. Grantees should take steps to enhance their registration system to permit the
capture and reporting of these data in the future.
LANGUAGE:
• Report on line 12 the number of patients who are best served in a language other than
English or in sign language.
• Include those patients who were served in a second language by a bilingual provider
and those who may have brought their own interpreter.
• Include patients residing in areas where a language other than English is the dominant
language such as Puerto Rico or the pacific islands.
NOTE: Data reported on line 12, Language, may be estimated if the health center does not
maintain actual data in its Practice Management System (PMS). Wherever possible, the
estimate should be based on a sample.
October xx, 2010
18 1
QUESTIONS AND ANSWERS FOR TABLES 3A AND 3B
DRAFT
1. Have the race data changed?
No. In general patients will be counted in the same racial category that they were counted in last
year. In 2008 an additional race category was added for “More than one race”. With the 2008
changes, the UDS classifications are now consistent with those used by the Census Bureau as per
the October 30, 1997, Federal Register Notice entitled, ‘‘Revisions to the Standards for the
Classification of Federal Data on Race and Ethnicity,’’ issued by the Office of Management and
Budget (OMB). These standards govern the categories used to collect and present federal data on
race and ethnicity. The OMB requires five minimum categories (White, Black or African American,
American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander) for race.
In addition to the five race groups, the OMB also states that respondents should be offered the
option of selecting more than one race. The addition of Line 6 permits reporting of those people
who have chosen to report two or more races.
2. How are patients of Hispanic/Latino ethnicity reported?
In 2009, Table 3B was revised to show race and ethnicity data in a matrix. Patients who were
once reported as Hispanic / Latino independent of race are now reported in Column A as
Hispanic/Latino. Patients are to be reported on lines 1 through 7 depending on their race. If
“Hispanic/Latino” is the only identity recorded in the center’s files, these patients will be reported in
column A on line 7 as having an “Unreported” racial identification.
3. How are individuals who receive different types of services or use more than one of the
grantee’s service delivery sites reported? For example, a person who receives both
medical and dental services or a woman who receives primary care from one clinic, but
gets prenatal care at another.
UDS Tables 3A and 3B provide unduplicated counts of patients. Grantees are required to report
each patient once and only once on Table 3A and on Table 3B, regardless of the type or number
of services they receive or where they receive them. Each person who has at least one visit
reported on Table 5 is to be counted once and only once on Table 3A and on Table 3B. Visits are
defined in detail in the “Definitions of Visits, Providers, Patients, and FTE” section (page 6). Note
the following:
• Persons who receive WIC services and no other services at the agency are not to be
counted as patients or reported on Table 3A or 3B (or anywhere on the UDS).
• Persons who only receive lab services or whose only service was an immunization or
screening test are not to be counted as patients or reported on Table 3A or 3B.
4. Do the numbers on Tables 3A and 3B tie to UDS data reported on other tables?
Yes. The sum of Table 3A, Line 39, Column A + B (total patients by age and gender) must equal
Table 3B, Line 8 column D (total patients by Hispanic/Latino Identity and Race); Total Patients by
Zip Code; Table 4, Line 6 (total patients by income); and Table 4 Line 12, Column A + B (total
patients by insurance status). The sum of Table 3A, Lines 1-20, Column A + B (total patients age
0-19 years) must equal Table 4, Line 12, Column A (total patients age 0-19 years).
5. Does race and Hispanic/Latino identity of all our patients need to be collected and reported?
Yes. The UDS requires the classification of race and Hispanic/Latino identity information in order
to assess health disparities across sub-populations. The format for the classification of this
information has been stipulated by OMB, and the UDS manual follows the standards established
by OMB. Grantees whose data systems do not support such reporting should endeavor to
enhance their systems to permit the required level of reporting rather than using the “unreported /
refused to report” categories.
October xx, 2010
19 1
6. Do I count my ARRA patients on this table?
To the extent that they qualify as patients, they are counted. Note that the ARRA program
maintains a cumulative count of patients and will require reporting a patient in 2010 reports who
was seen only in 2009. This is not the case with the UDS. Grantees will report only those ARRA
patients who were actually seen in 2010.
DRAFT
7. I have a separate data system for my Mental Health patients. How do I include their data on
these tables.
Grantees are required to unduplicate their data so that the UDS report counts patients only once,
regardless of the number of different types of services they receive. This may require the
downloading and merger of data from each system in order to eliminate duplicates, or to check
them manually. This can be a time consuming and potentially expensive process and should be
initiated as soon as the year ends to ensure sufficient time to complete it prior to the initial
submission date.
October xx, 2010
20 1
Reporting Period: January 1, 2010 through December 31, 2010
DRAFT
TABLE 3A – PATIENTS BY AGE AND GENDER
AGE GROUPS
MALE PATIENTS
(a)
FEMALE
PATIENTS
(b)
NUMBER OF PATIENTS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
October xx, 2010
Under age 1
Age 1
Age 2
Age 3
Age 4
Age 5
Age 6
Age 7
Age 8
Age 9
Age 10
Age 11
Age 12
Age 13
Age 14
Age 15
Age 16
Age 17
Age 18
Age 19
Age 20
Age 21
Age 22
Age 23
Age 24
Ages 25 – 29
Ages 30 – 34
Ages 35 – 39
Ages 40 – 44
Ages 45 – 49
Ages 50 – 54
Ages 55 – 59
Ages 60 – 64
Ages 65 – 69
Ages 70 – 74
Ages 75 – 79
Ages 80 – 84
Age 85 and over
TOTAL PATIENTS
(SUM LINES 1-38)
21 1
Reporting Period: January 1, 2010 through December 31, 2010
DRAFT
TABLE 3B – PATIENTS BY HISPANIC OR LATINO IDENTITY / RACE /
LANGUAGE
PATIENTS BY HISPANIC OR LATINO IDENTITY
PATIENTS BY RACE
HISPANIC/
LATINO (a)
NOT
HISPANIC/
LATINO (b)
UNREPORTED
/ REFUSED TO
REPORT (c)
TOTAL
(d)
NUMBER OF PATIENTS
1.
Asian
2a.
Native Hawaiian
2b.
Other Pacific Islander
2.
Total Hawaiian/Pacific Islander
(SUM LINES 2A + 2B)
3.
Black / African American
American Indian / Alaska
Native
White
4.
5.
6.
7.
8.
More than one race
Unreported / Refused to
report
TOTAL PATIENTS (SUM LINES
1+2 + 3 TO 7)
PATIENTS BY LANGUAGE
NUMBER
(a)
NUMBER OF PATIENTS
12.
PATIENTS BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH
October xx, 2010
22 1
INSTRUCTIONS FOR TABLE 4 – SELECTED PATIENT CHARACTERISTICS
DRAFT
Table 4 provides descriptive data on selected characteristics of health center patients. The table is
included in both the Universal Report and the Grant Reports. Note that patients supported through
the ARRA programs ARE INCLUDED in this report to the extent that they qualify under all other UDS
rules.
For the Universal Report, include all patients receiving at least one face-to-face visit for services
within the scope of any of the programs covered by UDS. The Grant Reports include only patients
who received at least one face-to-face visit that was within the scope of the program in question. All
patients reported on the Grant Report will also be reported on the Universal Report. Note that no cell
in a Grant Report may contain a number larger than the corresponding cell in the Universal Report.
Patients are to be reported only once per section in each report filed.
Cross Table Check: The sum of Table 3A, Line 39, Column A + B (total patients by age and gender)
must equal Table 3B, Lines 8 column D (total patients by race and Hispanic/Latino identity); Table 4,
Line 6 (total patients by income); and Table 4 Line 12, Column A + B (total patients by medical
insurance status). The sum of Table 3A, Lines 1-20, Column A + B (total patients age 0-19 years)
must equal Table 4, Line 12, Column A (total patients age 0-19 years).
INCOME AS PERCENT OF POVERTY LEVEL, LINES 1 - 6
Grantees are expected to collect income data on all patients, but are not required to collect this
information more frequently than once during the year. If income information is updated during the
year, report the most current information available. As a rule, family income is used. Except for
minor-consent services, children will always be classified in terms of their parent’s income. Patients
for whom the information was not collected within a year of their last visit must be reported on line 5
as unknown. Do not attempt to allocate patients with unknown income. Knowing that a patient is
homeless or a migrant or on Medicaid is not adequate to classify that patient as having an income
below the poverty level.
Income is defined in ranges relative to the Federal poverty guidelines (e.g., < 100 percent of the
Federal poverty level). In determining a patient’s income relative to the poverty level, grantees should
use official poverty guidelines defined and revised annually. The official Poverty Guidelines are
published in the Federal Register during the first quarter of each year. (At the time of this writing, the
poverty guidelines have not been updated for 2010. The guidelines for CY-2009, which are still in
effect, are available at http://aspe.hhs.gov/poverty/09poverty.shtml)
Every patient reported on Table 3A must be reported once (and only once) on Table 4 lines 1 through
5. The sum of Table 3A, Line39, Column A + B (total patients by age and gender) must equal Table 4,
Line 6 (patients by income). The same is true for Grant Reports.
PRINCIPAL THIRD PARTY MEDICAL INSURANCE SOURCE, LINES 7 - 12
This portion of the table provides data on patients by principal source of insurance for primary medical
care services. A patient’s health insurance may change during the year. Report on this table the
primary health insurance the patient had at the time of their last visit regardless of whether or not that
insurance was billed for or paid for the visit. (Other forms of insurance, such as dental or vision
October xx, 2010
23 1
coverage, are not reported.) Patients are divided into two age groups (Column A) 0 - 19 and (Column
B) age 20+. Primary patient medical insurance is divided into seven types as follows:
• Uninsured (Line 7) – Patients who do not have medical insurance at the time of the last visit
are counted on line 7. This includes patients whose visit was paid for by a third party source
that was not an insurance, such as EPSDT, BCCCP or some state or local safety net program.
Do not count patients as uninsured if their medical insurance did not pay for their visit. For
example, a patient with Medicare who was seen for an (uncovered) dental visit is still classified
as having Medicare for this table.
DRAFT
•
CHIP or CHIP-RA (Line 8b or 10b) – The Children’s Health Insurance Program Reauthorization
Act (also known as CHIP-RA) provides primary health care coverage for children and, on a
state by state basis, others – especially mothers or parents of these children. CHIP coverage
can be provided through the state’s Medicaid program and/or through contracts with private
insurance plans. In some states that make use of Medicaid, it is difficult or even impossible to
distinguish between “regular Medicaid” and “CHIP-Medicaid”. In other states the distinction is
readily apparent (e.g., they may have different cards). Even where it is not obvious, CHIP
patients may still be identifiable from a “plan” code or some other embedded code in the
membership number. This may also vary from county to county within a state. Obtain
information from the state and/or county on their coding practice. If there is no way to
distinguish between regular Medicaid and CHIP Medicaid, classify all covered patients as
“regular” Medicaid. In those states where CHIP is contracted through a private third party
payor, participants are to be classified as “other public-CHIP” (Line 10b) not as private, even if
the third party is, in fact, a traditional third party payor such as Blue Cross.
•
Medicaid (Line 8a, 8b and 8) – State-run programs operating under the guidelines of Titles XIX
(and XXI as appropriate) of the Social Security Act. Medicaid includes programs called by
State-specific names (e.g., California’s “Medi-Cal” program). In some states, the Children’s
Health Insurance Program (CHIP) is also included in the Medicaid program – see above.
While Medicaid coverage is generally funded by Federal and State funds, some states also
have “State-only” programs covering individuals ineligible for Federal matching funds (e.g.,
general assistance recipients) and these individuals are also included on Lines 8a, 8b and 8.
NOTE: Individuals who are enrolled in Medicaid but receive services through a private
managed care plan that contracts with the State Medicaid agency are still reported as
“Medicaid", not as privately insured.
•
Medicare (Line 9) – Federal insurance program for the aged, blind and disabled (Title XVIII of
the Social Security Act).
•
Other Public Insurance (Line 10a) – State and/or local government programs, such as
Washington’s Basic Health Plan or Massachusetts’ Commonwealth plan, providing a broad set
of benefits for eligible individuals. Include public paid or subsidized private insurance not listed
elsewhere. Do not include any CHIP, Medicaid or Medicare patients on this line. Do not
include uninsured individuals whose visit may be covered by a public source with limited
benefits such as the Early Prevention, Screening, Detection and Treatment (EPSDT) program
or the Breast and Cervical Cancer Control Program, (BCCCP), etc. ALSO DO NOT INCLUDE
persons covered by workers' compensation, as this is not health insurance for the patient, it is
liability insurance for the employer.
•
Other Public (CHIP) (Line 10b) – CHIP programs which are run through the private sector,
often through HMOs. The coverage may appear to be a private insurance plan (such as Blue
Cross / Blue Shield) but is funded through CHIP.
October xx, 2010
24 1
•
Private Insurance (Line 11) – Health insurance provided by commercial and non-profit
companies. Individuals may obtain insurance through employers or on their own. Private
insurance includes insurance purchased for public employees or retirees such as Tricare,
Trigon, Veterans Administration, the Federal Employees Benefits Program, etc.
DRAFT
Every patient reported on Table 3A must be reported once (and only once) on lines 7 through 11.
Note that there is no “unknown” insurance classification on this table – BPHC requires grantees obtain
medical coverage (if any) from all patients in order to maximize third party payments. The sum of
Table 3A, Line 39, Column A + B (total patients by age and gender) must equal Table 4, Line 12
Column A + B (total patients by insurance status.) The same is true for Grant Reports.
PATIENTS BY SOURCE OF INSURANCE
Grantees should report the patient’s primary health insurance covering medical care, if any, as of
the last visit during the reporting period. Primary insurance is defined as the insurance plan/
program that the grantee would normally bill first for services rendered. NOTE: Patients who have
both Medicare and Medicaid, would be reported as Medicare patients because Medicare is billed
before Medicaid. The exception to the Medicare first rule is the Medicare-enrolled patient who is still
working and insured by both an employer-based plan and Medicare. In this case, the principal health
insurance is the employer-based plan, which is billed first.
In rare instances a patient may have an insurance which the grantee cannot or does not bill. This may
be a patient who is enrolled in Medicaid, but assigned to another primary care provider, or a patient
with a private insurance where the grantees’ providers have not been credentialed to bill that payor. In
these instances the grantee will still report the patient as being insured and report the type of
insurance.
Patients for whom no other information is available, whose services are paid for by grant
programs, including family planning, BCEDP, immunizations, TB control, as well as patients
served in correctional facilities, may be classified as uninsured.
Similarly, patients whose services are subsidized through State/local government “indigent
care programs” are considered to be uninsured. Examples of state government “indigent care
programs” include New Jersey Uncompensated Care Program, NY Public Goods Pool Funding,
California’s Expanded Assistance for Primary Care, and Colorado Indigent Care Program.
For both Medicaid and Other Public Insurance, the table distinguishes between “regular” enrollees and
enrollees in CHIP.
MEDICAID = Line 8b includes Medicaid-CHIP enrollees only; Line 8a includes all other
enrollees; and Line 8 is the sum of 8a + 8b.
OTHER PUBLIC = Line 10b includes CHIP enrollees who are covered by a plan other than
Medicaid; Line 10a includes all other persons with other public insurance (Grantees are asked
to describe the programs so the UDS editor can make sure that the classification of the
program as other public is appropriate.); and Line 10 is the sum of 10a + 10b.
MANAGED CARE UTILIZATION, LINES 13a – 13c
This section on “Managed Care Utilization” is to report patient Member Months in managed care
plans. Do not report in this section enrollees in Primary Care Case Management (PCCM) programs
October xx, 2010
25 1
which pay a small monthly fee (less than $10 per member per month) to “manage” patient care. Do
not include managed care enrollees whose capitation or enrollment is limited to behavioral health or
dental services only, though an enrollee who has medical and dental (for example) is counted.
DRAFT
MEMBER MONTHS: A member month is defined as 1 member being enrolled for 1 month. An individual
who is a member of a plan for a full year generates 12 member months; a family of 5 enrolled for 6
months generates (5 X 6) 30 member months; etc. Member month information can often be obtained
from monthly enrollment lists generally supplied by managed care companies to their providers.
Grantees should always save these documents and, in the event they have not been saved, should
request duplicates early so as to permit timely filing of the UDS report.
MEMBER MONTHS FOR MANAGED CARE (CAPITATED) (Line 13a) – Enter the total capitated
member months by source of payment. This is derived by adding the total enrollment reported
from each capitated plan for each month. A patient is in a capitated plan if the contract
between the grantee and the Health Maintenance Organization (HMO) stipulates that for a flat
payment per month, the grantee will perform all of the services on a negotiated list. This
usually includes, at a minimum, all office visits. Payments are received regardless of whether
any service is rendered to the patient in that particular month. In the case of Medicaid,
Medicare, and CHIP-RA, it is common for there to be a second “wrap-around” payment for
managed care visits to adjust total payment to FQHC/PPS rates.
MEMBER MONTHS FOR MANAGED CARE (FEE-FOR-SERVICE) (Line 13b) – Enter the total fee-forservice member months by source of payment. A fee-for-service member month is defined as
one patient being assigned to a service delivery location for one month during which time the
patient may use only that center’s services, but for whom the services are paid on a fee-forservice basis. NOTE: It is common for patients to have their primary care covered by
capitation, but other services, such as behavioral health or pharmacy, paid separately on a feefor-service basis as a “carve out” in addition to the capitation, Do not include member months
for individuals who receive “carved-out” services under a fee-for-service arrangement if those
individuals have already been counted for the same month as a capitated member month.
TOTAL MEMBER MONTHS. (Line 13c) – Enter the total of lines 13a + 13b
CHARACTERISTICS OF TARGETED SPECIAL POPULATIONS, LINES 14 - 26
This section on “characteristics” asks for a count of patients from targeted special populations
including persons who are homeless, migrant and seasonal agricultural workers, patients who are
served by school-based health centers, and patients who are veterans.
MIGRANT OR SEASONAL AGRICULTURAL WORKERS AND THEIR DEPENDENTS, LINES 14 - 16
All grantees are required to report on Line 16 the combined total number of patients seen during the
reporting period who were either migrant or seasonal agricultural workers or their dependents. Section
330(g) grantees (only) are required to provide separate totals for migrant and for seasonal agricultural
workers on Lines 14 and 15. For Section 330(g) grantees, Lines 14 + 15 = 16.
DEFINITIONS OF MIGRANT AND SEASONAL AGRICULTURAL WORKERS
MIGRANT AGRICULTURAL WORKERS – Defined by Section 330(g) of the Public Health Service Act,
a migrant agricultural worker is an individual whose principal employment is in agriculture on a
seasonal basis (as opposed to year-round employment) and who establishes a temporary home
for the purposes of such employment. Migrant agricultural workers are usually hired laborers who
are paid piecework, hourly or daily wages. The definition includes those individuals who have had
October xx, 2010
26 1
such work as their principle source of income within the past 24 months as well as their
dependent family members who have also used the center. The dependent family members may
or may not move with the worker or establish a temporary home. Note that agricultural workers
who leave a community to work elsewhere are just as eligible to be classified as migrants in their
home community as are those who migrate to a community to work there.
DRAFT
SEASONAL AGRICULTURAL WORKERS – Seasonal agricultural workers are individuals whose
principal employment is in agriculture on a seasonal basis (as opposed to year-round
employment) and who do not establish a temporary home for purposes of employment. Seasonal
agricultural workers are usually hired laborers who are paid piecework, hourly, or daily wages.
The definition includes those individuals who have been so employed within the past 24 months
and their dependent family members who have also used the center.
For both categories of workers, agriculture is defined as farming in all its branches, including(i)
cultivation and tillage of the soil;
(ii)
the production, cultivation, growing and harvesting of any commodity grown on, in,
or as an adjunct to or part of a commodity grown in or on, the land; and
(iii)
any practice (including preparation and processing for market and delivery to
storage or to market or to carriers for transportation to market) performed by a
farmer or on a farm incident to or in conjunction with an activity describes in clause
(ii)
Persons employed in aquaculture, lumbering, poultry processing, cattle ranching, tourism and all
other non-farm-related seasonal work are not included.
HOMELESS PATIENTS, LINES 17 - 23
All grantees are to report the total number of patients, known to have been homeless at the time of
any service provided during the reporting period, on Line 23. Only section 330(h) Homeless Program
grantees will provide separate totals for homeless program patients by type of shelter arrangement.
•
•
•
•
•
The shelter arrangement reported is the patient’s arrangement as of the first visit during the
reporting period. This is normally assumed to be where the person was housed the prior night.
Persons who spent the prior night incarcerated, in an institutional treatment program (mental
health, substance abuse, etc.) or in a hospital should be reported based on where they intend
to spend the night after their visit/release. If they do not know, code as “street”.
“Street” includes living outdoors, in a car, in an encampment, in makeshift housing/shelter or in
other places generally not deemed safe or fit for human occupancy.
Section 330(h) Homeless Program grantees should report previously homeless patients now
housed but still eligible for the program on Line 21, “other”.
Patients residing in SRO (single room occupancy hotels) or motels or other day-to-day paid for
housing should be classified as “other”, line 21.
HOMELESS PATIENTS – Are defined as patients who lack housing (without regard to whether the
individual is a member of a family), including individuals whose primary residence during the night
is a supervised public or private facility that provides temporary living accommodations, and
individuals who reside in transitional housing.
SCHOOL BASED HEALTH CENTER PATIENTS, LINE 24
All grantees that identified a school based health center as a service delivery site in their grant
application and scope of project description are to report the total number of patients who received
primary health care services at the school service delivery sites(s) listed. A school based health
center is a health center located on or near school grounds, including pre-school, kindergarten, and
October xx, 2010
27 1
primary through secondary schools, that provides on-site comprehensive preventive and primary
health services.
DRAFT
VETERANS, LINE 25
All grantees report the total number of patients served who have been discharged from the uniformed
services of the United States. It is expected that this element will be included in the patient
information / intake form at each center. Report only those who affirmatively indicate they are
veterans. Persons who do not respond or who have no information are not counted, regardless of
other indicators. Persons who are still in the uniform services, including soldiers on leave and
National Guard members not on active duty, are not considered Veterans, Veterans of other nation’s
military are not counted here, even if they served in wars in which the United States was also involved.
October xx, 2010
28 1
QUESTIONS AND ANSWERS FOR TABLE 4
DRAFT
1. Are there any changes to this table?
No, however the definition of agriculture has been modified to quote precisely the language of the
statute. It is not anticipated that this will significantly alter the number of individuals reported as
farmworkers.
2. If we do not receive direct support under the Health Care for the Homeless, or Migrant
Health programs, do we need to report the total number of special population patients
served?
Yes. All grantees, regardless of whether they receive targeted grant funding for special
populations, are required to complete line 23 (total number of patients known to have been
homeless at the time of service), line 16 (the total number of patients seen during the reporting
period who were either migrant or seasonal agricultural workers or their dependents), line 24
(patients of an approved, in-scope school based clinic – regardless of whether or not special
funding was ever obtained for that clinic), and line 25 (Veterans). Grantees who did not receive
special population funding are not required to complete Lines 14-15 and 17-22.
3. Must the number of patients by income and insurance source equal the total number of
unduplicated patients reported on Tables 3A and 3B?
Yes.
4. We have never collected information on whether or not a patient is a veteran. Do we have
to do this now for reporting?
Yes. As of January 1, 2008 all grantees are required to ask every patient who comes into their
health center whether or not they are a veteran and add this to their profile so it can be reported.
5. If a patient is seen only for dental care do we report the patient’s dental insurance on lines
7 - 12?
No. Table 4 reports the medical coverage that health center patients have. All grantees must
collect medical coverage information from all patients even if the patient is not seeking medical
services. Note: If a patient has Medicaid, Private or Other Public dental insurance you may
presume that they have the same kind of medical insurance. It they do not have dental insurance
you may not assume that they are uninsured for medical care, and must obtain this information
from the patient.
6. How are ARRA supported patients counted on this table?
ARRA patients are counted the same way as any other patient. If they had a UDS countable visit
in 2010 they are included in all of the counts.
7. My ARRA grant says to count a patient as uninsured if they were uninsured at any time
during the ARRA grant period. Do I count them the same way on the UDS?
No. On the UDS, insurance status as of the last visit is what gets reported. An ARRA patient may
be reported as uninsured on the HCQR report, but if they had Medicaid (for example) at the time of
their last visit, you would count them on line 8a as a Medicaid patient.
October xx, 2010
29 1
TABLE 4 – SELECTED PATIENT CHARACTERISTICS
DRAFT
NUMBER OF PATIENTS
(a)
CHARACTERISTIC
INCOME AS PERCENT OF POVERTY LEVEL
1.
100% and below
2.
101 – 150%
3.
151 – 200%
4.
Over 200%
5.
Unknown
6.
TOTAL (SUM LINES 1 – 5)
PRINCIPAL THIRD PARTY MEDICAL INSURANCE SOURCE
0-19 YEARS OLD ( a )
7.
None/ Uninsured
8a. Regular Medicaid (Title XIX)
8b. CHIP Medicaid
8.
TOTAL MEDICAID (LINE 8A + 8B)
9.
MEDICARE (TITLE XVIII)
10a. Other Public Insurance Non-CHIP (specify:)
10b. Other Public Insurance CHIP
10.
TOTAL PUBLIC INSURANCE (LINE 10a + 10b)
11.
PRIVATE INSURANCE
12.
TOTAL (SUM LINES 7 + 8 + 9 +10 +11)
MANAGED CARE UTILIZATION
Payor Category
13a.
Capitated Member months
13b.
Fee-for-service Member months
MEDICAID
MEDICARE
(a)
(b)
OTHER PUBLIC
INCLUDING NONMEDICAID CHIP
(c)
13c. TOTAL MEMBER MONTHS ( 13a + 13b)
CHARACTERISTICS – SPECIAL POPULATIONS
14.
Migrant
(330g grantees only)
15.
Seasonal
(330g grantees only)
TOTAL MIGRANT/SEASONAL AGRICULTURAL WORKER OR
16.
DEPENDENT (ALL GRANTEES REPORT THIS LINE)
17.
Homeless Shelter
(330h grantees only)
18.
Transitional
(330h grantees only)
19.
Doubling Up
(330h grantees only)
20.
Street
(330h grantees only)
21.
Other
(330h grantees only)
22.
Unknown
(330h grantees only)
23.
TOTAL HOMELESS (ALL GRANTEES REPORT THIS LINE)
24.
TOTAL SCHOOL BASED HEALTH CENTER PATIENTS
TALL GRANTEES REPORT THIS LINE)
25.
TOTAL VETERANS (ALL GRANTEES REPORT THIS LINE)
October xx, 2010
20 AND OLDER ( b )
PRIVATE
TOTAL
(d)
(e)
NUMBER OF PATIENTS -- (a)
30 1
INSTRUCTIONS FOR TABLE 5 – STAFFING AND UTILIZATION
DRAFT
This table provides a profile of grantee staff, the number of visits they render and the number of
patients served by service category. Unlike Tables 3A, 3B, and 4, where an unduplicated count of
patients is reported, Column C of Table 5 is designed to report the number of unduplicated patients
within each of seven service categories: medical, dental, mental health, substance abuse, vision, other
professional, and enabling. The staffing information in Table 5 is designed to be compatible with
approaches used to describe staff for financial/cost reporting, while ensuring adequate detail on staff
categories for program planning and evaluation purposes. (NOTE: Staffing data are reported only on
the Universal table, not the Grant Report tables.)
For the Universal Report, all staff, all visits and all patients are reported in Columns A, B and C. For
the Grant Reports, only Columns B and C are to be completed. (Column A will appear “grayed
out” in the computer version and printouts of the Grant Report tables.) Every eligible visit must be
counted on the Universal Report including all those reported in the Grant Reports. Grant Reports
provide data on patients supported by funds which are within the scope of one of the non-CHC
programs and the visits which they had during the year. This includes all visits supported with either
grant or non-grant funds. Note that no cell in a Grant Report may contain a number larger than the
corresponding cell in the Universal Report.
Staff, visits and patients who are supported in whole or in part with ARRA related funds ARE included
in this report to the extent that they qualify under all other UDS rules.
FULL TIME EQUIVALENTS (FTEs), COLUMN A
This table includes FTE staffing information on all individuals who work in programs and activities that
are within the scope of the project for all of the programs covered by UDS. (The FTE column is
completed only on the Universal Report. Staff are not separated according to the different BPHC
funding streams.) All staff are to be reported in terms of annual Full-Time Equivalents (FTEs). A
person who works 20 hours per week (i.e., 50 percent time) is reported as “0.5 FTE.” (This example is
based on a 40 hour work week. Positions with less than a 40 hour base, especially clinicians, should
be calculated on whatever they have as a base for that position. Agencies which have a 35 hour work
week would consider 17.5 hours worked to be 0.5 FTE, etc.) Similarly, an employee who works 4
months out of the year would be reported as “0.33 FTE” (4 months/12 months). (See the “Full-Time
Equivalent Employee” section, page 10 of this Manual for detailed instructions on calculating FTEs).
Staff may provide services on behalf of the grantee under many different arrangements including, but
not limited to: salaried full-time, salaried part-time, hourly wages, National Health Service Corps
assignment, under contract, or donated time. Thus, FTEs reported on Table 5 Column A include paid
staff, volunteers, contracted personnel (paid based on worked hours or FTE), interns, residents and
preceptors. Individuals who are paid by the grantee on a fee-for-service basis only are not counted in
the FTE column since there is no basis for determining their hours.
All staff time is to be allocated by function among the major service categories listed. For example, a
full-time nurse who works solely in the provision of direct medical services would be counted as 1.0
FTE on Line 11 (Nurses). If that nurse provided case management services during 10 dedicated
hours per week, and provided medical care services for the other 30 hours per week, time would be
allocated 0.25 FTE case manager (Line 24) and 0.75 FTE nurse (Line 11). Do not, however, attempt
to parse out the components of an interaction. The nurse who handles a referral after a visit as a part
of that visit would not be allocated out of nursing. The nurse who vitals a patient who they then place
October xx, 2010
31 1
in the exam room, and later provide instructions on wound care, for example, would not have a portion
of the time counted as “health education” – it is all a part of nursing.
DRAFT
An individual who is hired as a full-time clinician must be counted as 1.0 FTE regardless of the number
of “direct patient care” or “face-to-face hours” they provide. Providers who have released time to
compensate for on-call hours or who receive leave for continuing education or other reasons are still
considered full-time if this is how they were hired. The time spent by providers doing “administrative”
work such as charting, reviewing labs, filling or renewing prescriptions, returning phone calls,
arranging for referrals, participating in QI activities, supervising nurses etc. is counted as part of their
overall medical care services time. The one exception to this rule is when a Medical Director is
engaged in corporate administrative activities, in which case time can be allocated to administration.
Corporate administration does not, however, include clinical administrative activities such as
supervising the clinical staff, chairing or attending clinical meetings, writing clinical protocols, etc.
PERSONNEL BY MAJOR SERVICE CATEGORY – Staff are distributed into categories that reflect the types
of services they provide. Major service categories include: medical care services, dental services,
mental health services, substance abuse services, vision services, other professional health services,
pharmacy services, enabling services, other program related services, and administration and facility.
Whenever possible, the contents of major service categories have been defined to be consistent with
definitions used by Medicare. The following summarizes the personnel categories; a more detailed
list appears in Appendix A.
•
MEDICAL CARE SERVICES (Lines 1 – 15)
Physicians - M.D.s and D.O.s, except psychiatrists, ophthalmologists, pathologists and
radiologists. Naturopaths and Chiropractors are not counted here. Note also that
Psychiatrists and Ophthalmologists are reported separately on lines 20a and 22a and
are not included on the physicians line.
Nurse Practitioners
Physician Assistants
Certified Nurse Midwives
Nurses - registered nurses, licensed practical and vocational nurses, home health and
visiting nurses, clinical nurse specialists, and public health nurses
Laboratory Personnel - pathologists, medical technologists, laboratory technicians
and assistants, phlebotomists
X-ray Personnel - radiologists, X-ray technologists, and X-ray technicians
Other Medical Personnel - medical assistants, nurses aides, and all other personnel
providing services in conjunction with services provided by a physician, nurse
practitioner, physician assistant, certified nurse midwife, or nurse. Staff who support
the quality assurance / Electronic Health Records (EHR) program. Medical records and
patient support staff are not reported here.
Note: Quality Assurance Personnel – Individuals in any or all of the above positions may
be involved in Quality Assurance and EHR activities. They will be classified on the line that
describes their main responsibility, not on the “IT” line.
•
DENTAL SERVICES (Lines 16 – 19)
Dentists - general practitioners, oral surgeons, periodontists, and pediodontists
Dental Hygienists
Other Dental Personnel - dental assistants, aides, and technicians
October xx, 2010
32 1
•
MENTAL HEALTH SERVICES (Lines 20a, a1, a2, b, c and 20) - (Note: Behavioral health
services include both mental health and substance abuse services. Centers using the
“Behavioral Health” designation need to divide their staff between lines 20 and 21 as
appropriate unless they choose to identify all services as Mental Health Services.)
Psychiatrists (Line 20a)
Licensed Clinical Psychologists (Line 20a-1)
Licensed Clinical Social Workers (Line 20a-2)
Other licensed mental health providers (Line 20b), including psychiatric social
workers, psychiatric nurse practitioners, family therapists, and other licensed Masters
Degree prepared clinicians.
Other mental health staff, including (Line 20c) unlicensed individuals, including
“certified” individuals who provide counseling, treatment or support services related
to mental health professionals.
DRAFT
•
SUBSTANCE ABUSE SERVICES (Line 21) - Psychiatric nurses, psychiatric social workers,
mental health nurses, clinical psychologists, clinical social workers, and family therapists and
other individuals providing counseling and/or treatment services related to substance abuse.
(Note: Behavioral health services are include both mental health and substance abuse
services. Centers using the “Behavioral Health” designation need to divide their staff between
lines 20 and 21 as appropriate.)
•
OTHER PROFESSIONAL HEALTH SERVICES (Line 22) - Occupational and physical therapists,
nutritionists, podiatrists, naturopaths, chiropractors, acupuncturists and other staff
professionals providing health services. Note: WIC nutritionists and other professionals
working in WIC programs are reported on Line 29a, Other Programs and Services Staff. (A
more complete list is included in Appendix A.) There is a “specify” box that must be
completed. Explain the specific other professional health services included.
•
VISION SERVICES (Lines 22a – 22d) – Persons working in the area of eye care, specifically
Ophthalmologist (Line 22a) – Medical doctors specializing in medical and surgical
eye problems.
Optometrist (Line 22b) – Optometrists (O.D.) – not physicians
Optometric Assistant (Line 22c)
•
PHARMACY SERVICES (Line 23) - Pharmacists (including clinical pharmacists), pharmacist
assistants and others supporting pharmaceutical services. Note that effective 2006, the time
(and cost) of individuals spending all or part of their time in assisting patients to apply for free
drugs from pharmaceutical companies are to be classified as “Eligibility Assistance Workers”,
on line 27a. Individual employees who do both should be allocated by time spent in each
category.
•
ENABLING SERVICES (Lines 24 - 29)
Case Managers (Line 24) - staff who provide services to aid patients in the
management of their health and social needs, including assessment of patient medical
and/or social services needs, and maintenance of referral, tracking and follow-up
systems. Case managers may provide eligibility assistance, if performed in the context
of other case management functions. Staff may include nurses, social workers and
other professional staff who are specifically allocated to this task during assigned
hours, but not when it is an integral part of their other function. Care / Referral
Coordinators are considered Case Managers.
October xx, 2010
33 1
-
Patient and Community Education Specialists (Line 25) - health educators, family
planning specialists, HIV specialists, and others who provide information about health
conditions and guidance about appropriate use of health services that are not
otherwise classified under outreach.
Outreach Workers (Line 26) - individuals conducting case finding, education or other
services to identify potential clients and/or facilitate access/referral of clients to
available services.
Eligibility Assistance Workers (Line 27a) – all staff providing assistance in securing
access to available health, social service, pharmacy and other assistance programs,
including Medicaid, WIC, SSI, food stamps, TANF, and related assistance programs.
Interpretation Staff (Line 27b) – Staff whose full time or dedicated time is devoted to
translation and/or interpretation services. DO NOT INCLUDE that portion of the time
of a nurse, medical assistant or other support staff who provides interpretation or
translation during the course of their other activities.
Personnel Performing Other Enabling Service Activities (Line 28) – all other staff
performing services as enabling services, not described above. There is a “specify”
field that must be used to describe what these staff are doing.
DRAFT
-
-
•
OTHER PROGRAMS AND RELATED SERVICES STAFF (Line 29a)
Some grantees, especially “umbrella agencies,” operate programs which, while within
their scope of service, are not directly a part of the listed medical, dental, behavioral or
other health services. These include WIC programs, job training programs, head start
or early head start programs, shelters, housing programs, child care, etc. The staff for
these programs are reported under Other Programs and Related Services. The cost
of these programs are reported on Table 8A on line 12. There is a “specify” field that
must be used to describe what these staff are doing.
•
ADMINISTRATION AND FACILITY (Lines 30 - 33)
Management and Support Staff – (Line 30a) – Management team including Chief
Executive Officer, Chief Financial Officer, Chief Information Officer and Chief Medical
Officer, other administrative staff and administrative office support (secretaries,
administrative assistants, file clerks, etc.) for health center operations within the scope
of the grant. Report only that portion of the management team’s full-time equivalent
corresponding to the management function.
Fiscal and Billing Staff – (Line 30b) - Staff performing accounting and billing
functions in support of health center operations for services performed within the
scope of the grant, excluding the Chief Financial Officer.
IT Staff – (Line 30c) - Technical information technology and information systems staff
supporting the maintenance and operation of the computing systems that support
clinical and administrative functions performed within the scope of the grant. Staff
managing an EHR/EMR system are reported on line 30c, but design of medical forms,
data entry and analysis of EHR data are part of the medical functions reported on lines
1 – 15.
Facility – (Line 31) - Staff with facility support and maintenance responsibilities,
including custodians, housekeeping staff, security staff, and other maintenance staff.
Patient Services Support Staff – (Line 32) - Intake staff and medical/patient records.
Eligibility assistance workers are reported on line 27a, not here.
NOTE: The Administration and Facility category for this report is more comprehensive than that used
in some other program definitions and includes all personnel working in a BPHC-supported program,
whether that individual's salary was supported by the BPHC grant or other funds included in the
October xx, 2010
34 1
scope of project. Where appropriate, staff included in a grantee’s overhead rate may be reported
here.
DRAFT
NOTE ALSO: Table 8A has data relating to cost centers. Staff classifications should be consistent with
cost classifications. The staffing on Table 5 is routinely compared to the costs on Table 8A during
the editing process. If there is a reason why such a comparison would look strange (e.g., volunteers
on Table 5 resulting in no cost on Table 8A) be sure to include an explanatory note on Table 8A. The
chart below illustrates the relationship between the two tables.
FTE’s reported on Table 5, Line:
1 – 12: Medical (physicians, mid-level providers, nurses)
13-14: Lab and X-ray
16 – 18: Dental (e.g., dentists, dental hygienists, etc.)
20a – 20: Mental Health
21: Substance Abuse
22: Other Professional (e.g. nutritionists, podiatrists, etc.)
22a-22d: Vision (Ophthalmologist, Optometrist, Optometric Assistant
23: Pharmacy
24 – 28: Enabling (e.g., case management, outreach, eligibility, etc.)
29a: Other programs / services (non-health related services
including WIC, job training, housing, child care, etc.)
30a – 30c and 32: Administration and Patient Support (e.g.,
corporate, intake, medical records, billing, fiscal and IT staff)
31: Facility (e.g., janitorial staff, etc.)
Have costs reported on
Table 8A, Line:
1: Medical staff
2: Lab and X-ray
5: Dental
6: Mental Health
7: Substance Abuse
9: Other Professional
9: Other Professional
8a: Pharmacy
11a – 11g: Enabling
12: Other related services
15: Administration
14: Facility
CLINIC VISITS, COLUMN B
VISITS (Column B) – A visit is a documented, face-to-face contact between a patient and a provider
who exercises their independent professional judgment in the provision of services to the patient. (See
“Definitions of Visits, Providers, Patients, and FTE” section, page 6, for further details on the definition
of visits). Grantees are to report visits during the reporting period which were rendered by staff
identified in column A, regardless of whether the staff are salaried, contracted or donated based on
time worked. No visits are reported for personnel who are not “providers who exercise independent
professional judgment” within the meaning of the definition above. In addition, the BPHC had chosen
not to require reporting grantees to report on visits for certain other classes of staff, even if they do
exercise professional judgment. In Column B, the cells applicable to these staff (e.g., laboratory,
transportation, outreach, pharmacy etc.) are blocked out.
Visits that are purchased from non-staff providers on a fee-for-service basis are also counted in this
column, even though no corresponding FTEs are included in Column A. To be counted, the service
must meet the following criteria:
• the service was provided to a patient of the Grantee by a provider that is not part of the
grantee's staff (neither salaried nor contracted on the basis of time worked),
• the service was paid for in full by the grantee, and
• the service otherwise meets the above definition of a visit.
This category does not include unpaid referrals, or referrals where only nominal amounts are
paid, or referrals for services that would otherwise not be counted as visits.
October xx, 2010
35 1
DRAFT
PATIENTS, COLUMN C
PATIENTS (Column C) – A patient is an individual who has at least one visit during the reporting year.
(See “Definitions of Visits, Providers, Patients, and FTE” section, page 9 for further details) Report the
number of patients for each of the seven separate services listed below. Within each category, an
individual can only be counted once as a patient. A person who receives multiple types of
services should be counted once (and only once) for each service.
For example, a person receiving only medical services is reported once (as a medical patient)
regardless of the number of medical visits. A person receiving medical, dental and enabling services
is reported once as a medical patient (Line 15), once as a dental patient (Line 19) and once as an
enabling patient (Line 29), but is counted only once on each appropriate line in column C, regardless
of the number of visits reported in column B. An individual patient may be counted once (and only
once) in each of the following categories:
•
•
•
•
•
•
•
Medical care services patients (Line 15)
Dental services patients (Line 19)
Mental health services patients (Line 20)
Substance abuse services patients (Line 21)
Vision care services patients (line 22d)
Patients receiving other professional services (Line 22)
Enabling services patients (Line 29)
If you show visits in Column B for any of these seven categories, you are required to show the
unduplicated number of patients who received these visits. Since patients must have at least one
documented visit, it is not possible for the number of patients to exceed the number of visits. Also,
individuals who only receive services for which no visits are generated (e.g., laboratory, transportation,
outreach) are not included in the patient count reported in Column C. For example, individuals who
receive outreach or transportation services are not included in the total number of patients receiving
enabling services in Column C; individuals who received flu shots but no other medical service are not
counted as medical patients, etc.
October xx, 2010
36 1
QUESTIONS AND ANSWERS FOR TABLE 5
DRAFT
1. Are there changes to this table?
Yes. Four lines have been added to capture Vision Care services. They have been added
because vision care is associated with reduced disabilities and costs associated with a number of
chronic illnesses as well as with eye diseases and disorders associated with normal aging. To
capture this data, several lines have been added to capture FTEs, visits and patients:
a.
Line 22a, Ophthalmologists and associated visits
b.
Line 22b, Optometrists and associated visits
c.
Line 22c, Optometric Assistants
d.
Line 22d, Total Vision Services (total of lines 22a-c) and Vision Services patients
e.
2. How do I count participants in a group session?
If you have group treatment sessions for substance abuse, mental health, or behavioral health you
must record the visit in each participant’s chart. If a visit is not recorded in a participant’s chart,
that participant may not be counted as a patient. Each patient must be billed consistent with
agency policy. If some patients / visits are billed and others are not billed, only those who are
billed may be counted. No group medical visits are counted on the UDS. Though in some
instances they may be billable, the UDS specifically does not count group medical activities as
visits in such sessions.
3. How do I report the FTEs for a clinician who regularly sees patients 75 percent of the time
and covers after-hours call the remaining 25 percent of his/her time?
An individual who is hired as a full-time clinician must be counted as 1.0 FTE regardless of the
number of “direct patient care” or “face-to-face hours” they provide. Providers who have released
time to compensate for on-call hours or hours spent on clinical committees, or who receive leave
for continuing education or other reasons are still considered full-time if this is how they were hired.
The time spent by providers doing administrative work such as charting, reviewing labs, filling
prescriptions, returning phone calls, arranging for referrals, etc. is not to be adjusted. The one
exception to this rule is when a Medical Director is engaged in corporate administrative activities,
in which case time can be allocated to administration. This does not, however, include clinical
administrative activities including chairing or attending meetings, supervising staff, and writing
clinical protocols. Note that the FQHC Medicare intermediary has different definitions for full time
providers. These definitions are not to be used in reporting on the UDS.
4. Our physicians work 35 hour weeks. Are they reported as 87.5% (35/40) FTEs?
No – they are each counted as 1.0 FTE. Grantees are not required by BPHC to have a 40 hour
work week, but whatever workweek they have must be considered full time.
5. Should the total number of patients reported on Table 3A be equal to the sum of the several
types of service patients on Table 5?
Not unless the only service you provide is medical services. On Table 5, the grantee reports
patients for each type of service, with the patient counted once for each type of service
received. Thus a person who receives both medical and dental services would be counted once
as a medical patient on Line 15 and once as a dental patient on Line 19. Because there are seven
different types of patients identified on Table 5, a patient who is counted only once on Table 3A
may be counted up to six different places on Table 5.
October xx, 2010
37 1
DRAFT
6. If I report costs for case management services on Table 8A, do I have to report case
managers on Table 5?
Yes. There should be a logical consistency between Table 5 and 8A. If a grantee reports that
costs for case management services one would expect to see case managers reported on Table 5.
Similarly, if there are staff on Table 5 we would expect costs on Table 8A unless all of the staff are
volunteers.
7. How are contracted providers and their activities reported on Table 5?
If the contracted provider is paid on the basis of time worked, the FTE is reported on Table 5
Column A as well as the visits and patients receiving services from this provider. If the contracted
provider is paid on a fee-for-service basis, no FTE is reported on Table 5 Column A but visits and
patients are reported.
8. Where does “Behavioral Health” get reported?
“Behavioral Health” in some systems is just another name for mental health, and the staff and
visits are reported on lines 20 through 20d. But some grantees have merged the roles of “Mental
Health Provider” and “Substance Abuse Provider” into a single role which they call “Behavioral
Health Provider.” In this instance, the grantee has two choices. The first (and probably easiest) is
to assert that substance abuse problems are, indeed, mental health problems, and classify their
Behavioral Health staff as Mental Health staff on the lines 20a, a1, a2, b or c. Another method
would be to carefully record the time and activities of these dual function providers. In this case
they will need to identify each and every visit as either a mental health visit or a substance abuse
visit so that the patients and visits can be correctly classified. They must also keep track of their
time so that their FTEs on table 5 (and associated costs on table 8A) can be accurately recorded.
9. If a clinician provides mental health and substance abuse (behavioral health) services to
the same patient during a visit, how should this be counted?
Because “substance abuse” is also seen as a mental health diagnosis, it is permissible to count
the visit as mental health. Under no circumstances would it be counted as “one of each.” The
provider will also need to be classified as mental health for this visit as must be the cost of the
provider on Table 8A.
10. Do I count the time of residents?
Yes. Residents are licensed practitioners and their time is counted just like any other practitioner.
Note, however, that most work shorter days because they are in educational sessions and often
have more vacation time or other time off than other practitioners. This would make them less
than full time. See also the discussion in Appendix B.
11. If I report patients and visits on my ARRA – HCQR, do I also count them on the UDS?
Yes – but please note that the cumulative ARRA report includes patients and visits from multiple
years. The UDS counts only those seen in the reporting year.
12. Do I count staff the same way on the UDS report as on the HCQR?
No – the UDS only counts FTE for the current program year and uses a slightly different
methodology for counting staff (see section on reporting Full time Equivalent Employee above).
October xx, 2010
38 1
DRAFT
TABLE 5 – STAFFING AND UTILIZATION
Personnel by Major Service Category
1
2
3
4
5
6
7
8
9a
9b
10
10a
11
12
13
14
15
16
17
18
19
20a
20a1
20a2
20b
20c
20
21
22
22a
22b
22c
22d
23
24
25
26
27
27a
27b
28
29
29a
30a
30b
30c
30
31
32
33
34
FTEs
(a)
Clinic Visits
(b)
Patients
(c)
Family Physicians
General Practitioners
Internists
Obstetrician/Gynecologists
Pediatricians
Other Specialty Physicians
Total Physicians (Lines 1 – 7)
Nurse Practitioners
Physician Assistants
Certified Nurse Midwives
Total “Mid-Levels” (Lines 9a - 10)
Nurses
Other Medical personnel
Laboratory personnel
X-ray personnel
Total Medical (Lines 8 + 10a through 14)
Dentists
Dental Hygienists
Dental Assistants, Aides, Techs
Total Dental Services (Lines 16 – 18)
Psychiatrists
Licensed Clinical Psychologists
Licensed Clinical Social Workers
Other Licensed Mental Health Providers
Other Mental Health Staff
Mental Health (Lines 20a-c)
Substance Abuse Services
Other Professional Services (specify___)
Ophthalmologist
Optometrist
Optometric Assistant
Total Vision Services (Lines 22a-c)
Pharmacy Personnel
Case Managers
Patient / Community Education Specialists
Outreach Workers
Transportation Staff
Eligibility Assistance Workers
Interpretation Staff
Other Enabling Services (specify___)
Total Enabling Services (Lines 24-28)
Other Programs / Services (specify___)
Management and Support Staff
Fiscal and Billing Staff
IT Staff
Total Administrative Staff (Lines 30a-30c)
Facility Staff
Patient Support Staff
Total Admin & Facility (Lines 30 – 32)
Total
Lines 15+19+20+21+22+22d+23+29+29a+33)
October xx, 2010
39 1
INSTRUCTIONS FOR TABLE 6A - SELECTED DIAGNOSES AND SERVICES
RENDERED
DRAFT
This table reports data on selected primary diagnoses and on selected services rendered. It is
designed to provide this information using data maintained for billing purposes. As a subset of
diagnoses and services, Table 6A is not expected to reflect the full range of diagnoses and services
rendered by a grantee. The diagnoses and services selected represent those that are prevalent
among BPHC patients or a sub-group of patients or are generally regarded as sentinel indicators of
access to primary care. Diagnoses reported on this table are those made by a medical, dental, mental
health or substance abuse provider, only, and are only the primary diagnosis provided at any given
visit. Thus, if a case manager sees a diabetic patient, the visit is not to be reported on Table 6A; if a
physician shows the primary diagnosis as hypertension and the secondary diagnosis as diabetes, the
diabetes diagnosis is not reported on Table 6A.
The table is included in both the Universal Report and Grant Reports.
• The Universal Report reports on visits in the indicated diagnostic or service categories
and a count of all individuals who had at least one visit in the indicated diagnostic or
service category within the scope of any and all BPHC - supported projects included in the
UDS.
• The Grant Report reports on only those visits provided to individuals served within the
scope of the program being reported on.
Selected Primary Diagnoses – Lines 1 through 20d present the name and applicable ICD-9CM
codes for the diagnosis or diagnostic range/group. Wherever possible, diagnoses have been grouped
into code ranges. Where a range of ICD-9CM codes is shown, grantees should report on all visits
where the primary diagnostic code is included in the range/group.
Selected Tests/Screenings/Preventive Services – Lines 21 through 26d present the name and
applicable ICD-9CM diagnostic and/or CPT procedure codes for selected tests, screenings, and
preventive services which are particularly important to the populations served. On several lines both
CPT codes and IC9 codes are provided. Grantees should use either the CPT codes or the ICD9 codes
for any specific visit, not both. Note that for these lines, the concept of a “primary” code is neither
relevant nor used. All services are reported. A reported service may be in addition to another service,
in addition to a reported primary diagnosis or may stem from a visit where there was no UDSreportable diagnosis code.
Note: “V-Codes” for mammography and Pap test are listed to ensure capture of procedures which are
done by the grantee, but coded with a different CPT code for state reimbursement under Title X or
BCCCP. Grantees must actually perform or pay for the test for it to be counted. Do not report referral
for tests or procedures which are not performed by or paid for by the grantee.
Selected Dental Services – Lines 27 through 34 present the name and applicable American Dental
Association (ADA) procedure codes for selected dental services. These services may be performed
only by a dental provider who is reported on lines 16 – 17. Wherever appropriate, services have been
grouped into code ranges. Note that for these lines, the concept of a “primary” code is neither relevant
nor used. All services are reported.
PLEASE NOTE: Only services which are provided at a “countable” visit are reported on table 6A.
Included in these would be services “attendant to” a countable visit. Thus, if a provider asks that a
patient come back in 30 days for a flu shot, when that patient presents, the shot is counted because it
is considered legally to be a part of the initial visit. Another person, walking in off the street for the
October xx, 2010
40 1
same flu shot but without a specific referral from a prior visit would not have the interaction reported on
Table 6A. Visits supported by the ARRA program ARE INCLUDED in this report as appropriate.
DRAFT
NUMBER OF VISITS, COLUMN A
LINES 1 – 20d: Diagnostic Data.
Visits by Selected Primary Diagnoses (Lines 1-20d). Report the total number of visits during the
reporting period where the indicated diagnosis is listed on the visit/billing records as the primary
diagnosis only. If a visit has a primary diagnosis which is one of the many diagnoses not listed on
Table 6A, it is not reported. While most visits are not reported on this table, those which are counted,
are reported for only the primary diagnosis on lines 1 through 20d. All visits entered into clinic practice
management / billing systems, with one diagnosis listed as primary and successive diagnoses listed
as secondary, tertiary, etc. Any single visit may be counted a maximum of one time on lines 1 – 20d
regardless of the number of diagnoses listed for the visit.
LINES 21 – 34: Service Data.
Visits by Selected Tests/Screenings/Preventive and Dental Services (Lines 21-34). Report the
total number of visits at which one or more of the listed diagnostic tests, screenings, and/or preventive
services were provided. Note that codes for these services may either be diagnostic (ICD-9) codes or
procedure (ADA or CPT-4) codes. During one visit more than one test, screening or preventive service
may be provided, in which case, each would be counted.
• One visit may involve more than one of the identified services in which case each should
be reported. For example, if during a visit both a Pap test and an HIV test were provided
then a visit would be reported on both lines 21 and 23.
• If a patient receives multiple immunizations at one visit, only one visit should be reported.
• Services may be reported in addition to diagnoses. A hypertensive patient who also
receives an HIV test would be counted once on the hypertension line 11 and once on line
21, HIV test.
• If a patient had more than one tooth filled, only one visit for restorative services should be
reported, not one per tooth.
NUMBER OF PATIENTS, COLUMN B
LINES 1 – 20d: Diagnostic Data.
Patients by Primary Diagnosis (Lines 1-20d). For Column B report each individual who had one or
more visits during the year where the primary diagnosis was the indicated diagnosis. A patient is
counted once and only once regardless of the number of visits made for that specific diagnosis. Any
patient may have visits with different primary diagnoses, for example, one for hypertension and one for
diabetes, on different days. In this case, the patient would be reported once for each primary diagnosis
used during the year. For example, a patient with one or more visits with a primary diagnosis of
hypertension and one or more visits with a primary diagnosis of diabetes is counted once and only
once as a patient on lines 9 and 11, regardless of how many times they were seen.
LINES 21 – 26d: Services Data.
Patients by Selected Diagnostic Tests/Screenings/Preventive Services (Lines 21-26d). Report
patients who have had at least one visit during the reporting period where the selected diagnostic
October xx, 2010
41 1
tests, screenings, and/or preventive services listed on Lines 21-26c was provided. If a patient had a
Pap test and contraceptive management during the same visit, this patient would be counted on both
Lines 23 and 25 in Column B. Regardless of the number of times a patient receives a given service,
they are counted once and only once on that line in Column B. For example, an infant who has an
immunization at each of several well child visits in the year has each visit reported in column A, but is
counted only once in column B.
DRAFT
LINES 27 – 34: Dental Services Data.
Patients by Selected Dental Services (Lines 27-34). Report patients who have had at least one visit
with a dental professional during the reporting period for each of the selected dental services listed on
Lines 27-34. (Services provided by persons other than a dentist or a dental hygienist may not be
reported here.) If a patient had two teeth repaired and sealants applied during one visit, this patient
would be counted once (only) on both Lines 30 and 32 in Column B.
October xx, 2010
42 1
QUESTIONS AND ANSWERS FOR TABLE 6A
DRAFT
1. Are there changes to this table?
Yes. Lines 1 and 2, (symptomatic and asymptomatic HIV) have been combined. In addition,
several new lines have been added including two new diagnoses and four new services.
Specifically:
4a. Hepatitis B
4b. Hepatitis C
21a. Hepatitis B test
21b. Hepatitis C test
26c. Smoking and tobacco use cessation counseling
26d. Comprehensive and intermediate eye exams
2. If a case manager or health educator serves a patient who is, for example, a diabetic, we
often show that diagnostic code for the visit. Should this be reported on Table 6A?
No. Report only visits with medical, dental, mental health, and substance abuse providers on Table
6A. Note also that each should diagnose only in their own area. Thus, dentists may not diagnose
hypertension, etc.
3. The instructions call for diagnoses or services at visits. If we provide the service, but it is
not counted as a visit (such as immunizations given at a health fair) should it be reported
on this table?
Services given at health fairs are not counted, regardless of who provides the service and the level
of documentation that is done. If a service is provided as a result of a prescription or plan from an
earlier visit that was counted it is counted. For example, if a provider asked a woman to come
back in four months for a mammogram that is done at the health center, it would be counted. But if
the service is a self-referral where no clinical visit is necessary or provided (such as a blood
pressure check at a health fair or a senior citizen coming in for a flu shot) it is not counted.
4. Some diagnostic and/or procedure codes in my system are different from the codes listed.
What do I do?
It is possible that information for Table 6A is not available using the codes shown because of
idiosyncrasies in state or clinic billing systems. Generally, these involve situations where (a) the
state uses unique billing codes, other than the normal CPT code, for state billing purposes (e.g.,
EPSDT) or (b) internal or state confidentiality rules mask certain diagnostic data. The following
provides examples of problems and solutions.
Line
Problem
#
1
HIV diagnoses are kept confidential and
and
alternative diagnostic codes are used.
2
Pap tests are charged to state BCCP
23
program using a special code
Well child visits are charged to the state
26 EPSDT program using a special code
(often starting with W, X, Y or Z).
Potential Solution
Include the alternative codes used at your
center on these lines as well.
Add these special codes to the other codes
listed.
Add these special codes to the other codes
listed and count all such visits as well. Do not
count EPSDT follow-up visits in this category.
5. The instructions specifically say that the source of information for Table 6A is “billing
systems.” There are some services for which I do not bill and/or for which there are no
visits in my system. What do I do?
October xx, 2010
43 1
Referrals for which you do not pay (e.g., sending women to the County Health Department for a
mammogram) are not to be counted. While grantees are only required to report data derived from
billing systems, the reported data may understate services in the circumstances described below.
In order to more accurately reflect your level of service, grantees are encouraged to use other
codes in their system to enable the tracking. For example, if a child is given a vaccination which
the clinic does not charge for because they received it free from the Vaccine for Children program,
the regular code with an extension may be used to indicate that it is not to be billed or the code
may have a zero charge attached to it.
DRAFT
Line #
Problem
Potential Solution
21
HIV Tests are collected by
us but processed and paid
for by the State and do not
show on the visit form or in
the billing system.
Preferred: Use the correct code, but show a
zero charge. Alternative: Use other data
sources such as logs of HIV tests conducted
or reports to Ryan White programs and use
this number of tests.
22
Mammograms are paid for,
but are conducted by a
contractor and do not show
in the billing system for
individual patients.
Preferred: Use the correct code, but show a
zero charge. Alternative: Use the bills from
the independent contractor to identify the
total number of mammograms conducted
during the course of the year and report this
number.
23
Pap tests are processed and
paid for by the State and do
not show on the visit form or
in the billing system.
Preferred: Use the correct code, but show a
zero charge. Alternative: Use other data
sources such as logs of Pap tests conducted
and use this number of tests.
24
Flu shots are not counted
because they are obtained
at no cost by the center.
Preferred: Use the correct code, but show a
zero charge. Alternative: Use the Medicare
cost report data on influenza vaccination
reimbursements as an estimate for the
number of actual visits where flu shots were
administered.
25
Contraceptive management
is funded under Title X or a
state family planning
program and does not have
a V-25 diagnosis attached to
it.
Preferred: Add a “dummy code” you can
map to the V-25 code. Alternative: Use
records developed for the Title X or state
family planning program to count the number
of family planning visits. Take care not to
count the same visit twice.
October xx, 2010
44 1
TABLE 6A – SELECTED DIAGNOSES AND SERVICES RENDERED
DRAFT
Applicable
ICD-9-CM
Code
Diagnostic Category
Number of Visits by
Primary Diagnosis
(A)
Number of
Patients with
Primary
Diagnosis
(B)
Selected Infectious and Parasitic Diseases
1-2.
Symptomatic HIV ,
Asymptomatic HIV
042 , 079.53, V08
3.
Tuberculosis
010.xx – 018.xx
4.
Syphilis and other sexually
transmitted diseases
090.xx – 099.xx
4a.
Hepatitis B
070.22, 070.22, 070.30, 070.32
4b.
Hepatitis C
070.41, 070.44, 070.51, 070.54,
070.70, 070.71
Selected Diseases of the Respiratory System
5.
Asthma
6.
Chronic bronchitis and
emphysema
493.xx
490.xx – 492.xx
Selected Other Medical Conditions
7.
Abnormal breast findings,
female
174.xx; 198.81; 233.0x; 238.3
793.8x
180.xx; 198.82;
233.1x; 795.0x
8.
Abnormal cervical findings
9.
Diabetes mellitus
10.
Heart disease (selected)
391.xx – 392.0x
410.xx – 429.xx
11.
Hypertension
401.xx – 405.xx;
12.
Contact dermatitis and other
eczema
692.xx
13.
Dehydration
276.5x
14.
Exposure to heat or cold
991.xx – 992.xx
14a.
Overweight and obesity
ICD-9 : 278.0 – 278.02 or V85.xx
excluding V85.0, V85.1, V85.51
V85.52
250.xx; 648.0x; 775.1x
Selected Childhood Conditions
15.
16.
17.
Otitis media and eustachian
381.xx – 382.xx
tube disorders
Selected perinatal medical
770.xx; 771.xx; 773.xx; 774.xx –
conditions
779.xx (excluding 779.3x)
Lack of expected normal
physiological development
(such as delayed milestone;
260.xx – 269.xx;
failure to gain weight; failure to
779.3x;
thrive)--does not include sexual
783.3x – 783.4x;
or mental development;
Nutritional deficiencies
1
DRAFT
TABLE 6A – SELECTED DIAGNOSES AND SERVICES RENDERED
Diagnostic Category
Applicable
ICD-9-CM
Code
Number of
Number of Visits by
Patients with
Primary Diagnosis
Primary Diagnosis
(A)
(B)
Selected Mental Health and Substance Abuse Conditions
18.
Alcohol related disorders
19.
Other substance related
disorders (excluding tobacco
use disorders)
19a
Tobacco use disorder
20a.
20b.
20c.
20d.
Depression and other mood
disorders
Anxiety disorders including
PTSD
Attention deficit and disruptive
behavior disorders
Other mental disorders,
excluding drug or alcohol
dependence (includes mental
retardation)
291.xx, 303.xx; 305.0x
357.5x
292.1x – 292.8x 304.xx, 305.2x –
305.9x 357.6x, 648.3x
305.1
296.xx, 300.4
301.13, 311.xx
300.0x, 300.2x, 300.3, 308.3,
309.81
312.8x, 312.9x, 313.81, 314.xx
290.xx
293.xx – 302.xx (excluding 296.xx,
300.0x, 300.2x, 300.3, 300.4,
301.13);
306.xx - 319.xx
(excluding 308.3, 309.81, 311.xx,
312.8x, 312.9x,313.81,314.xx)
TABLE 6A – SELECTED SERVICES RENDERED
Applicable
ICD-9-CM or CPT-4
Code
Selected Diagnostic Tests/Screening/Preventive Services
Service Category
Number of
Patients
(B)
CPT-4: 86689;
86701-86703;
87390-87391
21.
HIV test
21a.
Hepatitis B test
CPT-4: 88704,88705, 87515-17
21b.
Hepatitis C test
CPT-4: 86803-04, 87520-22
22.
Mammogram
23.
Pap test
24.
Selected Immunizations:
Hepatitis A, Hemophilus
Influenza B (HiB),
Pneumococcal, Diptheria,
Tetanus, Pertussis (DTaP)
(DTP) (DT), Mumps, Measles,
Rubella, Poliovirus, Varicella,
Hepatitis B Child)
24a
Seasonal Flu vaccine
CPT-4: 90655 - 90662
24b
H1N1 Flu vaccine
CPT-4: 90663; 90470
October xx, 2010
Number of Visits
(A)
CPT-4: 77052, 77057
OR
ICD-9: V76.11; V76.12
CPT-4: 88141-88155; 8816488167, 88174-88175 OR
ICD-9: V72.3; V72.31; V76.2
CPT-4: 90633-90634, 90645 –
90648;
90669; 90696 – 90702;
90704 – 90716; 90718 - 90723;
90743 – 90744; 90748
46 1
25.
Contraceptive management
ICD-9: V25.xx
DRAFT
26.
26a
26b
26c
26d
Health supervision of infant or
child (ages 0 through 11)
Childhood lead test screening
(9 to 72 months)
Screening, Brief Intervention,
and Referral to Treatment
(SBIRT)
Smoke and tobacco use
cessation counseling
Comprehensive and
intermediate eye exams
Service Category
CPT-4: 99391-99393;
99381-99383;
CPT-4: 83655
CPT-4: 99408-99409
CPT-4: 99406 and 99407;
S9075
CPT-4: 92002, 92004, 92012,
92014
Applicable
ADA
Code
Number of Visits
(A)
Number of
Patients
(B)
Selected Dental Services
27.
I. Emergency Services
28.
II. Oral Exams
29.
Prophylaxis – adult or
child
30.
Sealants
31.
Fluoride treatment – adult or
child
32.
III. Restorative Services
33.
IV. Oral Surgery
(extractions and other
surgical procedures)
34.
V. Rehabilitative services
(Endo, Perio, Prostho,
Ortho)
ADA : D9110
ADA : D0120, D0140, DO145,
D0150, D0160, D0170, D0180
ADA : D1110, D1120,
ADA : D1351
ADA : D1203, D1204, D1206
ADA : D21xx – D29xx
ADA : D7111, D7140, D7210,
D7220, D7230, D7240, D7241,
D7250, D7260, D7261, D7270,
D7272, D7280
ADA : D3xxx, D4xxx, D5xxx ,
D6xxx, D8xxx
Sources of codes:
International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Volumes 1 and
2, 2009 / 2010. American Medical Association.
Current Procedural Terminology, (CPT) 2009 / 2010. American Medical Association.
Current Dental Terminology, (CDT) 2009 / 2010. American Dental Association.
Note: x in a code denotes any number including the absence of a number in that place.
October xx, 2010
47 1
INSTRUCTIONS FOR TABLE 6B – QUALITY OF CARE INDICATORS
DRAFT
This table reports data on selected quality of care indicators. The quality of care indicators are
commonly seen in the health care community as indicators of overall community health. These
indicators are “process measures” which means that they document services which are thought to be
correlated with and serve as a proxy for good long term health outcomes. We know that individuals
who receive timely routine and preventive care are more likely to have improved health status. Thus,
by increasing the proportion of health center patients who receive timely routine and preventive care,
we can expect improved health status of the patient population in the future. Specifically:
•
•
•
Early entry into prenatal care: If women enter care in their first trimester then the probability of
adverse birth outcome will be reduced.
Childhood immunizations: If children receive their vaccinations in a timely fashion then they will be
less likely to contract vaccine preventable diseases or to suffer from the sequela of these diseases
Pap tests: If women receive Pap tests as recommended then they can be treated earlier and will
be less likely to suffer adverse outcomes from HPV and cervical cancer
While the selected quality of care measures give a good overall description of the overall quality of
primary care being provided at the center, it is clear that this is a subset of possible quality of care
indicators and that individual health centers may be using others in addition to these. It is BPHC’s
intent to add to these indicators for 2011 and collect additional data in 2012. Grantees will be notified
when approval is obtained from the Office of Management and Budget.
Table 6B is included only in the Universal Report, and includes patients and services supported by the
ARRA program.
DEMOGRAPHIC CHARACTERISTICS OF PRENATAL CARE PATIENTS, SECTIONS A
AND B
Only grantees that provide or assume primary responsibility for some or all of a patient's prenatal care,
whether or not the grantee does the delivery, are required to complete Sections A and B. Grantees
who do not provide prenatal care will indicate this by checking a box at the beginning of the table.
SECTION A: AGE OF PRENATAL CARE PATIENTS (Lines 1-6)
Report the total number of patients who received prenatal care services at any time during
the reporting period by age group. Be sure to include all women receiving any prenatal care,
including the delivery of her child, during the reporting year regardless of when that care was
initiated, including women who began prenatal care during the previous reporting period and
continued into this reporting period and women who began their care in this reporting period
but will not / did not deliver until the next year. Total prenatal patients include patients who
began care with another provider, patients who were transferred to another provider at some
point during their prenatal care and patients who were delivered by another provider. To
determine the appropriate age group, use the woman's age on June 30 of the reporting
period.
2
Note that this is a minor change from prior years. In prior years patients who delivered in early days of the
new year but had their last prenatal care visit in the prior year were not counted. This table counts those
women as well. Thus, a woman whose last prenatal care visit was in December, 2009 who delivered in
January, 2010 will be reported on the 2010 table.
October xx, 2010
48 1
SECTION B: TRIMESTER OF ENTRY INTO PRENATAL CARE (Lines 7-9)
All patients who received prenatal care including but not limited to the delivery of a child2
during the reporting period, are reported on lines 7– 9. The trimester (line) is determined by the
trimester of pregnancy that the woman was in when she began prenatal care either at one of
the grantee's service delivery locations or with another provider. A woman who begins her
prenatal care with the grantee is reported in Column A. A woman who begins her prenatal care
at another provider and then transfers to the grantee, is counted once and only once in Column
B, and is not counted in Column A. Prenatal care is considered to have begun at the time the
patient has her first visit with a physician or midlevel provider who initiates prenatal care with a
complete physical exam. Prenatal care is not initiated when the prenatal patient registers for
care at the center or has lab tests or psycho-social or nutritional assessments done. A woman
is counted only once regardless of the number of trimesters during which she receives care. In
those rare instances where a woman is in treatment for two separate perinatal courses of care
in the same year, she is to be counted twice.
DRAFT
FIRST TRIMESTER (Line 7) Includes women who received prenatal care during
the reporting period and whose first visit occurred when she was estimated to be
pregnant anytime through the end of the 13th week after conception 3 . If the
woman began prenatal care during the first trimester at the grantee's service
delivery location, she is reported on Line 7 in Column A; if she received prenatal
care from another provider during the first trimester before coming to the grantee's
service delivery location, she is reported on Line 7 in Column B, regardless of
when she begins care with grantee.
SECOND TRIMESTER (Line 8) Includes women who received prenatal care
during the reporting period and whose first visit occurred when she was estimated
to be between the start of the 14th week and through the 26th week after
conception. If the woman began prenatal care during the second trimester at the
grantee's service delivery location, she is reported on Line 8 in Column A; if she
received prenatal care starting in the second trimester from another provider before
coming to the grantee's service delivery location, she is reported on line 8 in
Column B, regardless of when she begins care with grantee.
THIRD TRIMESTER (Line 9) Includes women who received prenatal care during
the reporting period and whose first visit occurred when she was estimated to be 27
weeks or more after conception. If the woman began prenatal care during the third
trimester at the grantee's service delivery location, she is reported on Line 9 in
Column A; if she received prenatal care from another provider starting the third
trimester before coming to the grantee's service delivery location, she is reported
on Line 9 in Column B, regardless of when she begins care with grantee.
The sum of the numbers in the six cells of lines 7 through 9 represents the total number of
women who received perinatal care from the grantee during the calendar year, and is equal
to the number reported on line 6. All prenatal women must be reported here, regardless of
when they entered care (this year or last year) or when they deliver (this year or next year.)
The sum of the six cells will equal the number on line 6 – patients by age.
CHILDHOOD IMMUNIZATIONS AND PAP TESTS, SECTIONS C AND D
3
Obstetricians commonly count time from last reported menstrual period (LMP). Since this is two weeks earlier
than conception, the first trimester would be considered up through 15 weeks post-LMP. The second trimester is
through 28 weeks post-LMP.
October xx, 2010
49 1
DRAFT
In these sections, grantees will report on the findings of their reviews of services provided to targeted
populations of current medical patients (i.e., medical patients who had a medical visit at least once
during the reporting period):
SECTION C: CHILDHOOD IMMUNIZATION (Line 10)
Children with at least one medical visit during the reporting period, who had their second
birthday during the reporting period, and who were first seen ever by the grantee prior to
their second birthday are to be reported. For the purposes of this year's reporting this
includes children whose date of birth is between January 1, 2008 and December 31, 2008.
SECTION D: PAP TESTS (Line 11)
Women aged 21 through 64 with at least one medical visit during the reporting period, who
were first seen by the clinic at some point prior to their 65th birthday are to be reported. For
the purposes of this year's reporting this includes women whose date of birth is between
January 1, 1946 and December 31, 1986. (Note – this is the same measure that had been
previously called “Women 24 through 64” for clarity purposes. No women aged 12, 22 or
23 should be included in the calculation of this measure.)
Data for this section may be obtained from an audit of charts selected through a process of
scientific random sampling or through the use of Electronic Health Records whose templates permit
the recovery of all records for 100% of the patients which fit the criteria described below.
For each of the two populations being surveyed, very rigid and specific definitions are to be used in
order to identify the universe from which the sample will be drawn. These are described in detail below
and must be carefully followed to avoid misreporting findings. (Special care must be taken since
mistakes in this area may potentially portray a higher or lower quality of care than is actually the case.)
COLUMN INSTRUCTIONS
COLUMN a: NUMBER OF PATIENTS IN THE "UNIVERSE"
Enter the total number of health center patients who fit the criteria as defined below. Note that
this will no doubt include a significant number of patients who have not received the specific service
being measured. Because these populations are initially defined in terms of age (and gender),
comparisons to the numbers on Table 3A will be made. But because the definitions are different,
the numbers will not be equal to those on Table 3A.
Column a will reflect the total number of patients meeting the criteria in the agency's total patient
population including all sites and all programs.
COLUMN b: NUMBER OF CHARTS SAMPLED OR EHR TOTAL
Enter the total number of health center patients from the universe (Column a) for whom data
have been reviewed. The number will either be all patients who fit the criteria (the universe) or a
scientifically drawn sample of 70 patients selected from all patients who fit the criteria. If a
sample is to be used it must be a sample of 70 and must be drawn from the entire user
population identified for the universe. Larger samples will not be accepted. Grantees may not
choose to select the same number of charts from each site or the same number for each
provider or use other stratification mechanisms that could result in over-sampling some group of
patients.
If an EHR is present it may be used in lieu of a chart review of a sample of charts if and only if:
•
The EHR includes every single clinic patient who meets the criteria described below for
October xx, 2010
50 1
inclusion in the universe.
Every item in the criteria is regularly recorded for all patients
The EHR has been in place long enough to be able to find the data required in prior year's
activities. This means a minimum of three years full operation for the EHR before it can be
used in lieu of chart audits.
DRAFT
•
•
If the EHR is to be used in lieu of the chart audit, the number in Column b will be equal to the
number in Column a.
COLUMN c: NUMBER OF CHARTS / RECORDS IN COMPLIANCE
Enter the total number of records which meet the requirement for compliance as discussed
below.
CHILDHOOD IMMUNIZATIONS (Line 10):
PERFORMANCE MEASURE: The performance measure is “Percentage of children with their
2nd birthday during the measurement year who are fully immunized on their second birthday.”
This is calculated as follows:
•
Numerator: Number of children among those included in the denominator who were fully
immunized on or before their 2nd birthday. A child is fully immunized if s/he has been
vaccinated or there is documented evidence of contraindication for the vaccine or a history of
illness for ALL of the following: 4 DTP/DTaP, 3 IPV, 1 MMR, 3 Hib, 3 HepB, 1VZV (Varicella)
and 4 Pneumoccocal conjugate prior to or on their 2nd birthday.
•
Denominator: Number of all children with at least one medical visit during the reporting
period, who had their 2nd birthday during the reporting period or a sample of these children.
For measurement year 2010, this includes all children with date of birth between January 1,
2008 and December 31, 2008. Children who were never seen by the clinic prior to their
second birthday are excluded, but anyone seen on or before their 2nd birthday is included in
the universe. There will no doubt be a number of children for whom no vaccination
information was available and/or who were first seen at a point when there was simply not
enough time to fully immunize them prior to their second birthday. They should still be
included in the universe and thus in the denominator.
TOTAL NUMBER OF PATIENTS WITH 2ND BIRTHDAY DURING MEASUREMENT YEAR, COLUMN
(a)
Enter number of children who:
• Were born between January 1, 2008 and December 31, 2008, and
• Had at least one medical visit during the reporting year, including children who were seen only
for the treatment of an acute or chronic condition and those who were never seen for well child
care and
• Were seen for the first time ever prior to their second birthday. (This could have been in 2008
or 2009.)
Include all children meeting this criterion regardless of whether they came to the clinic
specifically for vaccinations or well child care, or they came for an injury or illness.
Children who had a contraindication for a specific vaccine should be included in the universe.
October xx, 2010
51 1
In your review they should be counted as being “compliant” for that specific vaccine and then
reviewed for the administration of the rest of the vaccines. Contraindications should be looked
for as far back as possible in the patient’s history. The following may be used to identify
allowable vaccination-exclusions:
DRAFT
Any particular vaccine: Contraindication: Allergic reaction to the vaccine or its components:
ICD-9: 999.4.
DTaP: Contraindication: Encephalopathy ICD-9: 323.5 (must include E948.4 or E948.5 or
E948.6 to identify the vaccine).
VZV and MMR: Contraindications:
Immunodeficiency, including genetic (congenital) immunodeficiency syndromes ICD-9:
279.
HIV-infected or household contact with HIV infection ICD-9: Infection V08, symptomatic
042 or 079.53.
Cancer of lymphoreticular or histiocytic tissue ICD-9: 200-202.
Multiple myeloma ICD-9: 203. Leukemia ICD-9: 204-208.
Allergic reaction to neomycin.
IPV: Contraindication: Allergic reaction to streptomycin, polymyxin B or neomycin.
Hib: Contraindication: None.
Hepatitis B: Contraindication: Allergic reaction to common baker’s yeast.
Pneumococcal conjugate: Contraindication: None.
NUMBER OF CHARTS SAMPLED OR EHR TOTAL, COLUMN (b)
Enter number of charts sampled in column b, or, if an EHR is used to report, copy the number from
column a. If a sample is used, the number of charts to be sampled equals all patients who fit the
criteria (the universe reported in column a) or a scientifically drawn sample of 70 patients from all
patients who fit the criteria. See discussion of sample size above on page 50.
NUMBER OF PATIENTS IMMUNIZED, COLUMN (c)
Enter in column c the number of children from column b who have received all of the following: 4
DTP/DTaP, 3 IPV, 1 MMR, 3 Hib, 3 HepB, 1VZV (Varicella) and 4 Pneumoccocal conjugate prior to or
on their 2nd birthday 4 . Count any of the following as documenting compliance for a given vaccine:
evidence of the antigen, contraindication for the vaccine, documented history of the illnesses, or a
seropositive test result. For combination vaccinations that require more than one antigen (i.e., DTaP
and MMR), find evidence of all the antigens.
o
DTaP/DT: An initial DTaP vaccination followed by at least three DTaP, DT or individual
diphtheria and tetanus shots, on or before the child's second birthday. Any vaccination
administered prior to 42 days after birth cannot be counted. In states where the law allows
an exception to a child who receives a pertussis vaccination, the child is compliant if he or
she has four diphtheria and four tetanus vaccinations.
o
IPV: At least three polio vaccinations (IPV) with different dates of service on or before the
child's second birthday. IPV administered prior to 42 days after birth cannot be counted.
o
MMR: At least one measles, mumps and rubella (MMR) vaccination, with a date of service
4
BPHC is proposing to add Rotavirus and Hepatitis A to this list for data collected in 2011 and reported in 2012.
Once approved by the Office of Management and Budget this will be officially announced to all grantees in a
Program Assistance Letter.
October xx, 2010
52 1
falling on or before the child's second birthday. (Note: CDC rules require that it be after the
first birthday, but that is not required for the UDS.)
DRAFT
o
HiB: Three H influenza type B (HiB) vaccination, with different dates of service on or before
the child's second birthday. HiB administered prior to 42 days after birth cannot be counted.
Note: because use of Comvax (a product which immunizes against both Hep B and Hib)
requires only three doses, the measure requires meeting the minimum possible standard of
three doses, rather than the recommended four doses, though the intent is to ensure
complete HiB vaccination.
o
Hepatitis B: Three hepatitis B vaccinations, with different dates of service on or before
the child's second birthday.
o
VZV (Varicella): At least one chicken pox vaccination (VZV), with a date of service falling on
or after the child's first birthday and on or before the child's second birthday.
o
Pneumococcal conjugate: At least four pneumococcal conjugate vaccinations on or
before the child's second birthday.
o
Combination 2 (DtaP, IPV, MMR, HiB, hepatitis B, VZV): Children who received four
DTaP/DT vaccinations; three IPV vaccinations; one MMR vaccination; three HiB
vaccinations; three hepatitis B; and one VZV vaccination.
o
Combination 3 (DtaP, IPV, MMR, Hib, hepatitis B, VZV, pneumococcal conjugate):
Children who received all of the antigens listed in combination 2 and four pneumococcal
conjugate vaccination.
The following ICD-9 and/or CPT codes are evidence of compliance. Additional vaccines for
these diseases – especially combination vaccines – may be approved during the year and
their CPT codes may be added by grantees to demonstrate compliance. Others listed here,
especially those for single diseases covered by the MMR or MMRV vaccines may no longer
be manufactured.
DTaP: CPT (90698, 90700, 90701, 90720, 90721, 90723; ICD-9 (99.39)
Diphtheria and tetanus: CPT (90702)
Diphtheria: CPT (90719); ICD-9(VO2.4*, 032*, 99.36)
Tetanus: CPT (90703); ICD-9 (037*, 99.38)
Pertussis: ICD-9 (033*, 99.37)
IPV: CPT (90698, 90713, 90723); ICD-9 (V12.02*, 045*, 99.41)
MMR: CPT (90707, 90708, 90710); ICD-9 (055*, 99.45)
Measles: CPT (90705, 90708); ICD-9 (055*, 99.45)
Mumps: CPT (90704,90710); ICD-9 (072*, 99.46)
Rubella: CPT (90706, 90707, 90708,90710); ICD-9 (056*, 99.47)
Hib: CPT (90645, 90646, 90647, 90648, 90698, 90720, 90721, 90748); ICD-9 (041.5*,
038.41*, 320.0*, 482.2*)
Hepatitis B*: CPT(90723, 90740, 90744, 90747, 90748); ICD-9 (VO2.61*, 070.2*, 070.3*)
VZV: CPT (90710, 90716); ICD-9 (052*, 053*)
Pneumococcal conjugate: CPT (90669)
* Indicates evidence of disease. A patient who has evidence of the disease prior to age
two is compliant for the antigen.
For immunization information obtained from the medical record, count patients where there is evidence
October xx, 2010
53 1
that the antigen was rendered from a note indicating the name of the specific antigen and the date of
the immunization, or a certificate of immunization prepared by an authorized health care provider or
agency including the specific dates and types of immunizations administered. Immunization
information may also be obtained from an immunization registry maintained by the State or other
public body as long as it shows comparable information, but immunization registries typically cannot
be used to identify the universe of patients.
DRAFT
For documented history of illness or a seropositive test result, find a note indicating the date of the
event. The event must have occurred by the patient's second birthday.
Notes in the medical record indicating that the patient received the immunization "at delivery" or "in the
hospital" may be counted toward the numerator. This applies only to immunizations that do not have
minimum age restrictions (e.g., prior to 42 days after birth). A note that the "patient is up-to-date" with
all immunizations that does not list the dates of all immunizations and the names of immunization
agents does not constitute sufficient evidence of immunization for this measure.
Also, good faith efforts to get a child immunized which fail remain “non-compliant” including:
•
Parental failure to bring in the patient
•
Parents who refuse for religious reasons
•
Parents who refuse because of beliefs about vaccines
Similarly, “catch-up” schedules are not recognized for the purpose of this reporting.
PAP TESTS (Line 11):
PERFORMANCE MEASURE. Percentage of women 21 - 64 years of age who received one or more
Pap tests to screen for cervical cancer. (Note – this is the same measure that had been previously
called “Women 24 through 64” for clarity purposes. No women aged 21, 22 or 23 should be included
in the calculation of this measure.)
•
Numerator: Number of female patients 24 - 64 years of age receiving one or more
documented Pap tests during the measurement year or during the two years prior to the
measurement year among those women included in the denominator. Because of the
difficulty in obtaining records from third parties, it is likely that a number of women will not
be able to be counted as compliant, even though the grantee has referred the patient for
services.
•
Denominator: Number of all female patients age 24 – 64 years of age during the
measurement year who had at least one medical visit during the reporting year, or a
sample of these women. For measurement year 2010, this includes patients with a date of
birth between January 1, 1946 and December 31, 1986.
TOTAL NUMBER OF FEMALE PATIENTS 24 - 64 YEARS OF AGE, COLUMN (a)
Enter the number of all female patients who:
•
Were born between January 1, 1946 and December 31, 1986 and
•
Were first seen by grantee prior to their 65th birthday and
•
Had at least one medical visit in a clinical setting 5 during 2010.
5
The requirement of “in a medical setting” is explicitly designed to exclude from the universe women
October xx, 2010
54 1
DRAFT
Exclude women who have had a hysterectomy and who have no residual cervix and for
whom the administrative data does not indicate a Pap test was performed. Look for
evidence of a hysterectomy as far back as possible in the patient's history, through either
administrative data or medical record review. Surgical codes for hysterectomy are: CPT
(51925, 56308, 58150, 58152, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270,
58275, 58280, 58285, 58290-58294, 58550, 58551, 58552-58554, 58951, 58953-58954,
58956, 59135) and ICD-9-CM (68.4-68.8, 618.5) NOTE: Because very few Health Centers
perform hysterectomies the chance of finding these CPT codes is small. The record may,
however, contain textual reference to the procedure, and should be searched for this in the
event no current Pap test is identified.
If a system cannot determine exclusions from the universe, “excludable” women may be
included in the universe and only later excluded from the sample, if identified. In these
cases, a replacement record will be used.
NUMBER OF CHARTS SAMPLED OR EHR TOTAL, COLUMN (b)
Enter the total number of health center patients from the universe (Column a) for whom data have
been reviewed. This will be all patients who fit the criteria or a scientifically drawn sample of 70
patients from all patients who fit the criteria. If a sample is to be used it must be a sample of 70 and
must be drawn from the entire user population. Larger samples will not be accepted. Grantees may
not choose to select the same number of charts from each site or the same number for each
provider or use other stratification mechanisms that result in oversampling some group of patients.
If a woman in the random selection is found to meet the exclusion criteria, the record is excluded
from the sample and another woman should be randomly selected to replace her. This can best
be accomplished by selecting replacement cases at the same time that the random sample is
identified.
NUMBER OF PATIENTS TESTED, COLUMN (c)
Enter the total number of female patients included in the sample who received one or more Pap tests
in a three year period from 2008 through 2010. Documentation in the medical record must include a
note indicating the date the test was performed and the result of the finding. A female patient is
counted as having had a Pap test if a submitted claim/visit contains any one of the following codes or
if a copy of a lab test performed by another provider is in the chart. A chart note which documents the
name, date, and results from a test performed by another provider which is based on communications
between the clinic and the provider is also acceptable .
CPT (88141-88145, 88148, 88150, 88152-88155, 88164-88167, 88174-88175) ICD-9-CM (91.46)
Do not count as compliant, charts which note a referral to a third party but which do not include a copy
of the lab report or a report of some form from the clinician / clinic that provided the test. Do not count
as compliant unsubstantiated statements from patients which cannot be backed up with
documentation.
encountered by homeless or farmworker programs in a field setting such as a park or encampment, or in an
outreach setting such as a shelter which cannot be configured to permit Pap tests to be conducted. Mobile clinics
that are designated by the grantee as approved “sites” are considered to be clinical settings and women seen in
these clinics are included in the universe.
October xx, 2010
55 1
QUESTIONS AND ANSWERS FOR TABLE 6B
DRAFT
1. Are there any changes to the table this year?
All elements in this table were present in 2008, however the specific CPT codes for vaccines
may have changed. .
2. A child came in only once in 2010 for an injury and never returned for well child care. If
her record is selected do we have to consider her chart to be out of compliance?
Yes. Once a patient enters a health center’s system of medical care, the center is
considered to be responsible to provide all needed preventive health care and/or document
that they have received it.
3. What if a woman we treat for hypertension and diabetes goes to an ObGyn in the
community for her women's health care. Do we still have to consider her part of our
sample for Pap tests? What if we do not do Pap tests?
Once the patient has been seen in your clinic, you are responsible for providing the Pap test or
documenting the results of a test that someone else performed. Health centers are
encouraged to document Pap tests by contacting providers of Pap tests directly in order to
obtain documentation by FAX, or by requesting that Health Center patients mail a copy of their
test history, or through other appropriate means. The woman would be considered to be a part
of your universe if she received any medical service(s) in 2010. If there is no copy of the results
of her Pap test included in her chart, she would be considered out of compliance.
4. If we pull a chart for a woman who we sent to the health department for her Pap test, but
the results are not posted, can we call the health department, get the results, post them,
and then count the chart as being in compliance?
The health center should obtain a copy of her test result to include in the patient’s record for
future care. However, the chart is still out of compliance for the reporting year (although the
record will now be valid for successive years depending on when the test was performed.)
5. If we inform a parent of the importance of immunizations but they refuse to have their
child immunized may we count the chart as being in compliance if the refusal is
documented?
No. A child is fully immunized if and only if there is documentation the child received the
vaccine or there is contraindication for the vaccine, evidence of the antigen, and history of
illness for all required vaccines.
6. Are parents required to bring to the health center documentation of childhood
immunizations received from outside the health center?
Parents are encouraged to provide documentation of immunizations that their children receive
elsewhere, but other mechanisms of obtaining this information are also acceptable. Health
centers are encouraged to document childhood immunizations by contacting providers of
immunizations directly in order to obtain documentation by FAX, or by requesting Health Center
patients to mail a copy of their immunization history, or by finding the child in a state or county
immunization registry or through other appropriate means. Health Center patients should not be
requested to return to the center merely to provide immunization documentation.
7. Some of the immunization details are different than those used by CDC in the CASA or
CO-CASA reviews of our clinic. May we use these CDC standards to report on the UDS?
No. In order to align the data from the UDS with data nationally, HRSA uses the vaccination
specifics set forth by the National Quality Forum. Using a different set of standards will distort the
October xx, 2010
56 1
data. Because data are being compared to Table 3A data, such misalignment may be detected
in which case grantees will be asked to resample their data. A center may use a different set of
standards for its own internal Quality Assurance program, but these may not be substituted for
the HRSA rules defined for the UDS reporting on Table 6B.
DRAFT
8. We want to use these reviews to compare our sites and our providers to one another. As
a result we would like to use a larger universe. Is there any problem with this?
Yes. First, all grantees using a sample must use 70 charts. This facilitates the development of
state, national and other roll-up reports. Second, and perhaps more important, any change in
the sample size as described would bias the sample and provide distortions in the data set.
9. What happens if the CPT codes change again?
The codes are reviewed annually by the UDS Help Line staff. If you think that there is a CPT
code for a vaccine or a Pap test which is not being reflected in the list, contact the UDS Help
Line. They will review the code with the BPHC and will incorporate approved changes to
codes into the manual of future reporting.
10. Is the Pap test review for women starting at age 21 or at age 24?
For this measure you will look only at women who were 24 years or older (up to age 65) at
some point in 2010. You will not look at any women who were 21, 22, or 23 years old at the
end of 2010. Because the measure asks about Pap tests administered in 2010 or in 2009 or
2008, it is possible that a 24 year old woman would have been 21 in 2008. If she received a
Pap test in that year she would be considered to be in compliance. So we are looking only at
women who are 24 to 64, but their qualifying test may have been received when they were 21
through 64. Grantees should take care to review charts only for women who were 24 through
64 in 2010 and should not select any charts for women who were younger.
October xx, 2010
57 1
TABLE 6B – QUALITY OF CARE INDICATORS
DRAFT
(NO PRENATAL CARE PROVIDED? CHECK HERE: )
SECTION A: AGE CATEGORIES FOR PRENATAL PATIENTS
(GRANTEES WHO PROVIDE PRENATAL CARE ONLY)
DEMOGRAPHIC CHARACTERISTICS OF PRENATAL CARE PATIENTS
AGE
1
2
3
4
5
6
NUMBER OF PATIENTS
(a)
LESS THAN 15 YEARS
AGES 15-19
AGES 20-24
AGES 25-44
AGES 45 AND OVER
TOTAL PATIENTS (SUM LINES 1 – 5)
SECTION B – TRIMESTER OF ENTRY INTO PRENATAL CARE
TRIMESTER OF FIRST KNOWN VISIT FOR
Women Having First Visit with
Women Having First Visit with
WOMEN RECEIVING PRENATAL CARE
Grantee
Another Provider
DURING REPORTING YEAR
(a)
(b)
7
First Trimester
8
Second Trimester
9
Third Trimester
SECTION C – CHILDHOOD IMMUNIZATION
TOTAL NUMBER
NUMBER CHARTS
NUMBER OF
ND
PATIENTS WITH 2
SAMPLED OR EHR
PATIENTS
BIRTHDAY DURING
CHILDHOOD IMMUNIZATION
TOTAL
IMMUNIZED
MEASUREMENT YEAR
(a)
10
(b)
(c)
NUMBER CHARTS
SAMPLED OR EHR
NUMBER OF
PATIENTS TESTED
Number of children who have
received required vaccines who
had their 2nd birthday during
measurement year (on or prior to
December 31)
SECTION D – PAP TESTS
PAP TESTS
11
TOTAL NUMBER OF
FEMALE PATIENTS
24-64 YEARS OF AGE
(a)
TOTAL
(b)
(c)
Number of female patients aged
24-64 who had at least one Pap
test performed during the
measurement year or during one
of the two previous calendar years
October xx, 2010
58 1
INSTRUCTIONS FOR TABLE 7 – HEALTH OUTCOMES AND DISPARITIES
DRAFT
This table reports data on selected health outcome indicators by race and Hispanic/Latino identity.
The health outcome indicators are commonly seen in the health care community as indicators of
overall community health. They are “intermediate outcome measures” which means that they
document measurable outcomes of clinical intervention as a proxy for good long term health
outcomes. Increasing the proportion of patients who have good intermediate health outcome,
generally leads to improved health status of the patient population in the future. Specifically:
•
•
•
Low Birthweight: If there are fewer low birthweight children born, then there will be fewer children
who suffer the multiple negative sequela of low birthweight, such as delayed or diminished
intellectual and/or physical development.
Controlled Hypertension: If there is less uncontrolled hypertension, then there will be less
cardiovascular damage, fewer heart attacks, less organ damage later in life.
Controlled Diabetes: If there is less uncontrolled diabetes then there will be fewer amputations,
less blindness, less organ damage later in life.
While the selected health outcome indicators give a good description of the overall quality of primary
care being provided at the center, it is clear that this is a subset of possible health outcome indicators
and that individual health centers may be using others in addition to these.
Table 7 reports health outcomes by race and Hispanic/Latino identity to provide information on the
extent to which health centers help reduce health disparities. Race and Hispanic/Latino identity is
self-reported by patients and should be collected as part of a standard registration process. Note that
using race and ethnicity data from the chart which is inconsistent with that in the registration data may
result in errors in reporting! Health centers who report on a sample of patients are cautioned against
using their data to evaluate disparities given small sample sizes. However, on a state and national
level, reported data will provide results which can be used to evaluate disparities for BPHC-funded
programs, overall.
The table is included only in the Universal Report.
HIV POSITIVE PREGNANT WOMEN, TOP LINE
All grantees are to report the total number of HIV positive pregnant women served by the
health center in column (i) regardless of whether or not they provide prenatal care services.
DELIVERIES AND LOW BIRTH WEIGHT BY RACE AND HISPANIC/LATINO IDENTITY,
SECTION A (LINES 1-5)
Only grantees that provide, or assume primary responsibility for, some or all of a patient's prenatal
care services, whether or not the grantee does the delivery, are required to complete Section A. All
health center prenatal care patients who delivered during the reporting period 6, and all children born
to them, are reported on lines 1 – 5. This table is similar to a table previously collected in the UDS,
but has a different population reported.
PRENATAL CARE PATIENTS WHO DELIVERED DURING THE YEAR (Line 1)
6
Note that this is a change from prior years. In prior years only those patients who also had a prenatal care visit
in the reporting period were counted, and some patients who delivered in the first few days of the new year were
left out. This new table counts those women as well.
October xx, 2010
59 1
Report the total number of women who were known to have delivered during the year, even if
the delivery was done by another provider. Grantees are required to follow up on women who
are referred out, and to track and report their deliveries and birth outcomes. Include all women
who had deliveries, regardless of the outcome, but do not include deliveries where you have no
documentation that the delivery occurred (for example, for women who may have moved out of
the area and/or who were lost to follow-up.)
DRAFT
DELIVERIES PERFORMED BY GRANTEE PROVIDER (Line 2)
Report the total number of deliveries performed by center clinicians during the reporting period
in Column i. (This line is not reported by the race / Hispanic/Latino identity of the women
delivered.) On this line ONLY, grantee is to include deliveries of women who were not part of
the grantee's prenatal care program during the calendar year. This would include such
circumstances as the delivery of another doctor's patients when the clinic provider participates
in a call group and is on call at the time of delivery; emergency deliveries when the clinic
provider is on-call for the emergency room; and deliveries of patients who are assigned to the
provider as a requirement for privileging at a hospital. Include as "health center clinicians" any
clinician who is paid by the center, regardless of the method of compensation. Do not include
deliveries where a clinic doctor bills separately, receives, and retains payment for the delivery.
BIRTHWEIGHT OF INFANTS BORN TO PRENATAL CARE PATIENTS WHO DELIVERED
DURING THE YEAR (Lines 3 – 5)
Report the total number of LIVE births during the reporting period for women who received
prenatal care from the grantee or referral provider during the reporting period, according to the
appropriate birthweight group.
NOTE: Grantees must report deliveries and the birthweight of live children delivered
for all women who were in their prenatal care program and who delivered during the
reporting period, regardless of whether the grantee did the delivery themselves,
referred the delivery to another provider or was for a woman who transferred to
another provider on her own.
The number of deliveries reported on line 1 will normally not be the same as the total number
of infants reported on lines 3 - 5 because of multiple births and still births.
HYPERTENSION AND DIABETES BY RACE AND HISPANIC/LATINO IDENTITY,
SECTION B
In these sections, grantees will report on the findings of their reviews of services provided to targeted
populations of current medical patients (i.e., medical patients who had at least two medical visits
during the reporting period):
SECTION B: HYPERTENSION (Lines 6-8)
The proportion of hypertensive patients whose most recent blood pressure showed a
systolic pressure under 140 and a diastolic pressure under 90 is calculated.
SECTION C: DIABETES (Lines 9-13)
The proportion of diabetic patients whose most recent HbA1c is in a given range: HbA1c
levels less than 7%, 7% to 9%, and greater than 9% is calculated 7 .
7
In 2011 BPHC intends to alter the reporting ranges for HbA1c to be consistent with those ranges identified in
the CMS Meaningful Use criteria. Once approved by the Office of Management and Budget, grantees will be
notified.
October xx, 2010
60 1
DRAFT
Data for this section may be obtained from an audit of charts selected through a process of
scientific random sampling or through the use of Electronic Health Records whose templates permit
the recovery of 100% of the records of the patients which fit the sampling profile.
For each of the two populations being surveyed, very specific definitions are to be used in order to
identify the universe from which the sample will be drawn. These are described in detail below and
must be carefully followed to avoid misreporting findings.
HYPERTENSION (Lines 6-8):
This section of Table 7 reports on all health center adult patients, 18 to 85 years of age, who
have been diagnosed as hypertensive before June 30 of the measurement year and have been
seen in the health center for medical services at least twice during the reporting year. (The
diagnosis may have first been made in a year prior to the measurement year.)
PERFORMANCE MEASURE: Proportion of patients born between January 1, 1925 and December
31,1992 with diagnosed hypertension (HTN) whose blood pressure (BP) was less than 140/90
(adequate control) at the time of the last reading. (Note: Many health centers use a different
measure for their quality assurance process for their diabetic or dialysis patients. This may well be
appropriate, but for the purposes of UDS reporting, the 140/90 measure must be used.)
•
Numerator: Number of patients with last systolic blood pressure measurement <140 mm Hg
and diastolic blood pressure < 90 mm Hg during the measurement year among those patients
included in the denominator.
•
Denominator: All patients 18 to 85 years of age as of December 31 of the measurement
year with a diagnosis of hypertension (HTN), who have been seen for medical services at
least twice during the reporting year, and who had a diagnosis of hypertension before June
30 of the measurement year whose chart was reviewed, or a valid sample of these patients.
TOTAL PATIENTS AGED 18 to 85 WITH HYPERTENSION, ROW 6
Enter the total number of patients by race and Hispanic/Latino identity who meet all of the
following criteria:
Were born between January 1, 1925 and December 31, 1992 and,
Have been seen at least twice during the reporting year for any medical service and ,
Have been diagnosed with hypertension (HTN) before June 30 of the measurement year
as evidenced by an ICD-9 code of 401.xx - 405.xx. It does not matter if hypertension was
treated or is currently being treated. The notation of hypertension may appear during or
prior to the year 2010. Hypertension may also be identified by finding any of the following
statements in chart notes, however it is not assumed that all charts will be screened for these
references:
• HTN
• High blood pressure (HBP)
• Elevated blood pressure
• Borderline HTN
• Intermittent HTN
• History of HTN
October xx, 2010
61 1
Statements such as "rule out hypertension," "possible hypertension," "white-coat hypertension,"
"questionable hypertension," and "consistent with hypertension" are not sufficient to confirm the
diagnosis of hypertension if such statements are the only notations hypertension in the medical
record.
DRAFT
Blood pressures that are self-reported by the patient such as when a patient calls in a blood pressure
from home are generally not eligible unless a clinical management decision is made using that reading.
If the patient is equipped with reliable technology and the provider is confident that the reading is
reliable such that the provider is recording the automated BP reading and making prescription changes
based on those readings, the health center can use the measurement.
CHARTS SAMPLED OR EHR TOTAL, ROW 7
Enter the total number of hypertensive health center patients by race and Hispanic/Latino identity for
whom data have been reviewed. In most cases this will be all patients who fit the criteria or a
scientifically drawn sample of 70 patients. If a sample is to be used it must be a sample of 70 and
must be drawn from the entire universe identified on row 6. Larger samples will not be accepted.
Grantees may not choose to select the same number of charts from each site or the same number
for each provider or use other stratification mechanisms that result in over-sampling some group of
patients. The sampling method is described in Appendix C. If an EHR is present it may be used in
lieu of a chart review of a sample of charts if and only if:
•
•
•
The EHR includes every single clinic patient between the ages of 18 and 85 with
diagnosed hypertension, regardless of whether or not they were specifically treated for
hypertension.
Blood pressure is regularly recorded in the EHR for all patients
The EHR has been in place throughout the reporting year – ideally for at least and three
years.
If the EHR is to be used, the number on line 7 will be equal to the number on line 6. NOTE: Your
PC-DEMS or PECS system may be used to report the universe ONLY IF it can be limited to a
calendar year report and only if it includes all required data elements, e.g., it includes data for the
required time frame for all hypertensive (or diabetic) patients from all service sites.
PATIENTS WITH CONTROLLED BLOOD PRESSURE, ROW 8
Hypertensive patients born between January 1, 1925 and December 31, 1992 whose charts have
been reviewed (those identified on line 7) whose systolic blood pressure measurement was less than
140 mm Hg and whose diastolic blood pressure was less than 90 mm Hg at the time of their last
measurement in 2010 are to be reported on line 8 by race and Hispanic/Latino identity. (Patients who
have not had their blood pressure tested during the reporting year will be counted as not meeting the
performance measure.)
IMPORTANT NOTES ABOUT RACE AND HISPANIC/LATINO IDENTITY NUMBERS:
1. Comparisons are made between the universe reported on Table 7, line 6 and the data reported
on Table 3B. Under no circumstances may a grantee report more hypertensive Hispanic/Latinos or
more hypertensive patients of any given race reported on line 6 than are reported on Table 3B.
2. Under most circumstances Column h will be relatively small. Use Column h only if, when you
ask a patient their race and whether or not they are Hispanic/Latino, they refuse to answer both
questions. Those who do provide their race but do not check that they are Hispanic/Latino on an
intake form should be considered non-Hispanic/Latino.
October xx, 2010
62 1
DRAFT
DIABETES (Lines 9-13):
This section of Table 7 reports on all HC patients 18 - 75 who have been diagnosed as diabetic at
some point during their time as a patient at the HC.
PERFORMANCE MEASURE: Proportion of adult patients born between January 1, 1935 and
December 31, 1992, with a diagnosis of Type I or Type II diabetes, whose most recent hemoglobin
A1c (HbA1c) was less than or equal to 9% will be calculated. Grantees are to report results in three
categories: less than 7% (good control); greater than or equal to 7% and less than or equal to 9%;
and greater than 9% (poor control).
•
Numerator: Number of adult patients whose most recent hemoglobin A1c level during the
measurement year is < 9% among those patients included in the denominator.
•
Denominator: Number of adult patients 18 – 75 as of December 31 of the measurement
year with a diagnosis of Type I or II diabetes who have been seen in the clinic for medical
services at least twice during the reporting year and do not meet any of the exclusion
criteria whose chart was reviewed.
TOTAL PATIENTS AGED 18 - 75 WITH TYPE I OR II DIABETES, ROW 9
Enter the number of adult patients by race and Hispanic/Latino identity who meet the following criteria:
• Were born between January 1, 1935 and December 31,1992 and,
• Have been seen at least twice for medical care during the reporting year and,
• Have a diagnosis of diabetes. It does not matter if diabetes was treated or is currently
being treated or when the diagnosis was made. The notation of diabetes may appear
during or prior to the 2010. To confirm the diagnosis of diabetes,
o one of the following codes must be found in the medical record:
ICD-9-CM Codes 250.xx, 648.0, or
o diabetic patients may also be identified from pharmacy data (those who were
dispensed insulin or oral hypoglycemics / antihyperglycemics.
Exclude any patients with a diagnosis of polycystic ovaries (ICD-9-CM Code 256.4) that do not have
two face-to-face visits with the diagnosis of diabetes, in any setting, during the measurement year
or year prior to the measurement year. 8 Also exclude any patients with gestational diabetes (ICD-9CM Code 648.8) or steroid-induced diabetes (ICD-9-CM Code 962.0, 251.8) during the
measurement year.
CHARTS SAMPLED OR EHR TOTAL, ROW 10
Enter the total number of diabetic health center patients by race and Hispanic/Latino identity for whom
data have been reviewed. In most cases this will be all patients who fit the criteria or a scientifically
drawn sample of 70 patients, using the methodology described in Appendix C. If a sample is to be
used it must be a sample of 70 and must be drawn from the entire user population defined as the
universe on line 9. Larger samples will not be accepted. Grantees may not choose to select the
same number of charts from each site or the same number for each provider or use other
8
If a search is made for pharmaceuticals that are used to treat diabetes, a person with these various conditions
might be identified in error – hence this exclusion. If no search is done for pharmacy identification of patients, this
can be ignored.
October xx, 2010
63 1
stratification mechanisms that result in over-sampling some group of patients. If an EHR is present it
may be used in lieu of a chart review of a sample of charts if and only if:
•
The EHR includes every diabetic patient.
•
Every item in the criteria is regularly recorded for all patients
•
The EHR has been in place throughout the performance year, and ideally for at least three
years to permit identification of all diabetic patients.
DRAFT
If the EHR is to be used in lieu of the chart audit, the number on line 10 will be equal to the number
on line 9.
REPORTED HEMOGLOBIN A1c LEVELS, ROW 11-13
For this report, the last hemoglobin A1c (HbA1c) level taken in the measurement year as
documented through laboratory data or medical record review, is reported. If there is no HbA1c
level during the measurement year, the chart will be reported on line 13: “greater than
9.0%”. Thus a patient with no test during the current year is counted with those who have poor
HbA1c control as being non-compliant.
•
•
•
Patients with HBA1c < 7% (Line 11): Number of patients included in the sample (i.e., in both
lines 9 and 10) whose most recent HbA1c was less than 7%.
Patients with 7% < HBA1c < 9% (Line 12): Number of patients included in the sample (i.e.,
in both lines 9 and 10) whose most recent HbA1c was greater than or equal to 7%, but less than
or equal to 9%.
Patients with HBA1c > 9% (Line 13): Number of patients included in the sample (i.e., in both
lines 9 and 10) whose most recent HbA1c was greater than 9% or patients who did not receive
a HbA1c test during the reporting year or whose test result is missing.
IMPORTANT NOTES ABOUT RACE AND HISPANIC/LATINO IDENTITY NUMBERS:
1. Comparisons are made between the universe reported on Table 7, line 9 and the data reported
on Table 3B. Under no circumstances may a grantee report more diabetic Hispanic/Latinos or
more patients from any given race reported on line 9 than are reported on Table 3B.
2. Under most circumstances Column h will be relatively small. Use Column h only if, when you
asked a patient their race and whether or not they are Hispanic/Latino, they refused to answer
both questions. Those who do provide their race but do not check that they are Hispanic/Latino
on an intake form should be considered non-Hispanic/Latino.
October xx, 2010
64 1
QUESTIONS AND ANSWERS FOR TABLE 7
DRAFT
1. Are there any changes to the table this year?
No.
2. When would we use Column h?
Column h will infrequently. It is to be used only in those instances where a patient refuses to
provide their race and refuses to state whether or not they are Hispanic/Latino. Patients who
provide a race, but do not answer affirmatively to a question about Hispanic/Latino identity are to
be classified as Non-Hispanic/Latino in the second set of columns.
3. Data are requested by race and Hispanic/Latino identity. How are these to be coded?
Race and Hispanic/Latino identity are coded on this table in the exact same manner that is used
for coding on Table 3B. Refer to instructions for Table 3B for further information.
4. Are patients with diabetes required to bring to the health center documentation of HbA1c
tests received from outside the health center?
Patients are encouraged to provide documentation of HbA1c immunizations received elsewhere,
but this is not required. Health centers are encouraged to document HbA1c tests by contacting
providers of tests directly in order to obtain documentation by FAX, or by requesting Health Center
patients to mail a copy of test results, or through other appropriate means. Health Center patients
should not be requested to return to the center merely to provide test documentation, however
failure to document results means that the patient must be reported as out of compliance.
5. We want to use these reviews to compare our sites and our providers to one another. As a
result, we would like to use a larger universe. Is there any problem with this?
Yes. First, all grantees using a sample must use 70 random charts. This facilitates the
development of state, national and other roll-up reports. Second, and perhaps more important,
any change in the sample size as described would bias the sample and provide distortions in the
data set.
October xx, 2010
65 1
DRAFT
TABLE 7 – HEALTH OUTCOMES AND DISPARITIES
Hispanic/Latino (1)
Non - Hispanic/Latino (2)
HIV Positive
Pregnant
Women
<>
(NO PRENATAL CARE PROVIDED? CHECK HERE:
Race Unreported /
Refused to report (g)
More than one race
(f)
White
(e)
American Indian /
Alaska Native ( d )
Black/African American
(c)
Pacific Islander
( b2 )
Native Hawaiian
( b1 )
(a)
Asian
Race Unreported /
Refused to Report (g)
More than one race
(f)
White
(e)
American Indian /
Alaska Native ( d )
Black/African American
(c)
Pacific Islander
( b2 )
Native Hawaiian
( b1 )
(a)
Asian
Unreported
---------------------------->
)
SECTION A: DELIVERIES AND BIRTH WEIGHT BY RACE AND HISPANIC/LATINO IDENTITY
1
Prenatal
care
patients
who
delivered
during
the year
2
Deliverie
s
performe
d by
Grantee
Provider
3
Live
Births
< 1500
grams
4
Live
Births
1500 –
2499
grams
5
Live
Births
≥ 2500
grams
October xx, 2010
<>
---------------------------->
66
/
Refused
to
Report
Race and
Identity
(h)
Total
(i)
DRAFT
Non - Hispanic/Latino (2)
Race Unreported /
Refused to report (g)
More than one race
(f)
White
(e)
American Indian /
Alaska Native ( d )
Black/African American
(c)
Pacific Islander
( b2 )
Native Hawaiian
( b1 )
Unreported
(a)
Asian
Race Unreported /
Refused to Report (g)
More than one race
(f)
White
(e)
American Indian /
Alaska Native ( d )
Black/African American
(c)
Pacific Islander
( b2 )
Native Hawaiian
( b1 )
(a)
Asian
Hispanic/Latino (1)
SECTION B: HYPERTENSION BY RACE AND HISPANIC/LATINO IDENTITY
Patients 18 to 85 diagnosed with hypertension whose last blood pressure was less than 140 / 90
6
7
8
Total
hypertensive
patients
Charts
sampled
or
EHR total
Patients
with HTN
controlled
SECTION C: DIABETES BY RACE AND HISPANIC/LATINO IDENTITY
Patients 18 to 75 diagnosed with Type I or Type II diabetes: Most recent test results
9
Total
patients
with
diabetes
Charts
sampled
or
EHR total
Patients with
11 HBA1c <
7%
Patients with
7% <
12
HBA1c <
9%
Patients with
HBA1c >
13 9% OR
No test
during year
10
October xx, 2010
67
/
Refused
to
Report
Race and
Identity
(h)
Total
(i)
DRAFT
INSTRUCTIONS FOR TABLE 8A - FINANCIAL COSTS
Table 8A must be completed by all BPHC grantees. It is included only in the Universal Report. The
table covers the total cost of all activities which are within the scope of the project(s) supported, in
whole or in part, by any of the four BPHC grant programs covered by the UDS including costs
covered by an ARRA grant. All costs are to be reported on an accrual basis. These are the costs
attributable to the period, including depreciation, regardless of when actual payments were made.
(Hence, only depreciation is reported for capital investments including ARRA – CIP or FIP grants.)
Under UDS rules grantees do not report bad debts or the repayment of the principle of a loan on
Table 8A.
DIRECT, OVERHEAD, AND LOADED COSTS (COLUMN DEFINITIONS)
Column A: This column reports the accrued direct costs associated with each of the cost centers /
services listed. See Line Definitions for costs to be included in each category. Column A also reports
the total cost of overhead (administration and facility) separately on Lines 14 and 15.
Column B: This column shows the allocation of overhead costs (from lines 14 and 15, Column A) to
each of the direct cost centers.
•
•
The total of facility and administration costs, reported in Column A, lines 14 and 15, are to be
distributed in Column B. The total amounts entered in Column B will thus equal the amount
reported on Line 16, Column A. Lines 1 and 3 both refer to aspects of the medical practice. It
is acceptable to report all medical overhead on Line 1 if a more appropriate allocation between
lines 1 and 3 is not available.
All pharmacy overhead is to be allocated to the non-supply line (Line 8a). No overhead costs
are reported on the pharmaceutical supplies line (line 8b) which is blacked out in the reporting
software.
The allocation of administration and facility costs should be done as follows, unless your center has
a more accurate system:
FACILITY COSTS should be allocated based on the amount of square footage utilized for
Medical, Lab and X-ray, Dental, Mental Health, Substance Abuse, Pharmacy, Other
Professional, Enabling, Other Program Related Services and Administration. Square Footage
refers to the portion of the grantee's facility space used in the operation of the organization, not
including common spaces such as hallways, rest rooms, and utility closets.
For reporting purposes, the square footage associated with space owned by the grantee and
leased or rented to other parties should not be included if it is considered to be outside of the
scope of the project. If it has been included inside the scope of project, it should be allocated to
Other Related Services (Row 12) and the rent received should be included on Table 9E under
Other Revenue (Line 10).
If you have an alternative allocation method that better allocates facility costs it may be used,
but be sure to save your work papers. Alternative methods often include the allocation of the
cost of each building separately – especially when the square foot costs of multiple buildings
varies dramatically.
ADMINISTRATIVE COSTS should be allocated after facility costs have been allocated, and
should include the facility costs allocated to administration. Administrative cost is allocated
October xx, 2010
68 1
based on a straight line allocation method. The proportion of total cost (excluding
administrative cost) that is attributable to each service category should be used to allocate
administrative cost. For example, if medical staff account for 50 percent of total cost (excluding
administration) then 50 percent of administrative cost is allocated to medical staff. If you
have an alternative method that provides more accurate allocations, it may be used, but
save your paperwork for review and explain the methods used in the table note.
DRAFT
Column C : This column shows the "fully loaded" cost of each of the cost centers listed on Lines 1 13. The loaded cost is the sum of the direct cost, reported in Column A, plus the allocation of
overhead, reported in Column B. This calculation is now done automatically in the reporting software.
Column C also shows the value of any donated facilities, services and supplies on Line 18. These
non-cash donations should be reflected as a positive number, and are not included in any of the lines
above. Note that this is the only place that the value of non-cash donations are shown. Non-cash
donations are never reported on Table 9E. Line 19, Column C is the total cost including the value of
donations. All UDS calculations which are based on “cost” are calculated based on costs without the
value of donated services supplies or facilities.
BPHC MAJOR SERVICE CATEGORIES (LINE DEFINITIONS)
MEDICAL CARE SERVICES (Lines 1 - 4) – This category includes costs for medical care personnel;
services provided under agreement; X-ray and laboratory; and other direct costs wholly attributable to
medical care (e.g., staff recruitment, equipment depreciation, supplies, or professional dues and
subscriptions). It does not include costs associated with pharmacy, dental care, substance abuse
specialists, mental health (psychiatrists, clinical psychologists, clinical social workers, etc.) or vision
care (ophthalmologists, optometrists, optometric assistants, etc.) services.
MEDICAL STAFF COSTS (Line 1) – Include all staff costs, including salaries and fringe
benefits for personnel supported directly or under contract, for medical care staff except
lab and x-ray staff. The accrued cost (if any) of interns and residents who were paid or
paid for, either directly or through a contract with their teaching institution, are reported on
line 1. The costs of intake, medical records and billing and collections are considered
administrative and should be included on Line 15 and allocated in Column B. Include the
cost for vouchered or contracted medical services on line 1. Include the cost of any
medical visit paid for directly by the center, such as at-risk specialty care from an HMO
contract or other specialty care on line 1.
MEDICAL LAB AND X-RAY COSTS (Line 2) – Include all costs for lab and x-ray,
including salaries and fringe benefits for personnel supported directly or under contract,
for lab and x-ray staff; and all other direct costs including, but not limited to, supplies,
equipment depreciation, related travel, contracted or vouchered lab and x-ray services,
etc. The costs of intake, medical records, billing and collections are considered
administrative and should be included on Line 15 and allocated in Column B. Note that
dental lab and x-ray costs are reported on the dental line, line 5.
OTHER DIRECT MEDICAL COSTS (Line 3) – Include all other direct costs for medical
care including, but not limited to, supplies, equipment depreciation, related travel, CME
registration and travel, laundering of uniforms, recruitment, membership in professional
societies, books and journal subscriptions, etc.
TOTAL MEDICAL (Line 4) – The sum of lines 1 + 2 + 3.
October xx, 2010
69 1
OTHER CLINICAL SERVICES (Lines 5 - 10) – This category includes staff and related costs for
dental, mental health, substance abuse services, pharmacy, vision, and services rendered by other
professional personnel (e.g., chiropractors, naturopaths, occupational and physical therapists, speech
and hearing therapists, and podiatrists).
DRAFT
DENTAL (Line 5) – Report all costs for the provision of dental services including but not
limited to staff, fringe benefits, supplies, equipment depreciation, related travel, dental lab
services and dental x-ray. Corporate administrative and facility costs should be included on
Line 15 Column A and allocated in Column B.
MENTAL HEALTH (Line 6) – Report all direct costs for the provision of mental health services,
other than substance abuse services, including but not limited to staff, fringe benefits,
supplies, equipment depreciation, and related travel. If a "behavioral health" program
provides both mental health and substance abuse services, the cost should be allocated
between the two programs. Allocations may be based on staffing or visits (from Table 5) or
any other appropriate methodology. Corporate administrative and facility costs should be
included on Line 15 Column A and allocated in Column B. (See also Q & A discussion for
table 5 on page 38.)
SUBSTANCE ABUSE (Line 7) – Report all direct costs for the provision of substance abuse
services including but not limited to staff, fringe benefits, supplies, equipment depreciation,
and related travel. If a "behavioral health" program provides both mental health and
substance abuse services, the cost should be allocated between the two programs, as should
associated staff on Table 5. Allocations may be based on staffing or visits (from Table 5) or
any other appropriate methodology. Corporate administrative and facility costs should be
included on Line 15 Column A and allocated in Column B. (See also Q & A discussion for
table 5 on page 38.)
PHARMACY (NOT INCLUDING PHARMACEUTICALS) (Line 8a) – Report all direct costs for
the provision of pharmacy services including but not limited to staff, fringe benefits, nonpharmaceutical supplies, equipment depreciation, related travel, contracted purchasing
services, etc. All corporate administrative and facility costs for lines 8a and 8b should be
included on Line 15 Column A and allocated on line 8a Column B. Include 100% of the cost
of clinical pharmacists on this line.
PHARMACEUTICALS (Line 8b) — Report all direct costs for the purchase of pharmaceuticals,
including the cost of vaccines and other injectable drugs. Do not include other supplies. Do
not include the value of donated pharmaceutical supplies (these are recorded on Line 18,
Column C.) No space is provided to report the overhead costs associated with the purchase
of pharmaceuticals. To the extent that there are such costs (they may well be lower than
what would otherwise be calculated) they are combined with pharmacy costs and reported on
line 8a.
OTHER PROFESSIONAL (Line 9) — Report all direct costs for the provision of other
professional and ancillary health care services including but not limited to: vision care,
podiatry, chiropractic, acupuncture, naturopathy, speech, occupational and physical therapy,
etc. (A more complete list appears at Appendix A.) Included in direct costs are staff, fringe
benefits, supplies, equipment depreciation, related travel, and contracted services.
Corporate administrative and facility costs should be included on Line 15 Column A and
allocated in Column B. Note that there is a cell to "specify" the other professional costs
reported on this line.
October xx, 2010
70 1
TOTAL OTHER CLINICAL (Line 10) — The sum of lines 5 + 6 + 7 + 8a + 8b + 9.
DRAFT
ENABLING AND OTHER PROGRAM RELATED SERVICES (Lines 11 - 13) – This category
includes enabling staff and related costs for case management, outreach, transportation, translation
and interpretation, education, eligibility assistance — including pharmacy assistance program
eligibility, environmental risk reduction and other services that support and assist in the delivery of
primary medical services and facilitate patient access to care. It also includes the cost of staff and
related costs for other program related services such as WIC, day care, job training, delinquency
prevention and other activities not included in other BPHC categories.
ENABLING (Line 11) — Enabling services include a wide range of services which support and
assist primary medical care and facilitate patient access to care. Line 11 is calculated
automatically as the total of the detail lines. It includes all direct costs for the provision of
enabling services including but not limited to costs such as staff, fringe benefits, supplies,
equipment depreciation, related travel, and contracted services. Corporate administrative and
facility costs should be included on Line 15 Column A and allocated in Column B.
Lines 11a — 11g provide room to detail six specific types of enabling services as well as an
"other" category for all other forms of enabling services:
•
Case Management (11a)
•
Transportation (11 b)
•
Outreach (11c)
•
Patient and community education (11d)
•
Eligibility assistance (including pharmacy program eligibility) (11e)
•
Translation / Interpretation Services (11f)
•
Other (11g)
If the "other" category is used, there is room to “specify” the other forms of enabling services
included on this line.
OTHER PROGRAM RELATED (Line 12) – Report all direct costs for the provision of
services not included in any other category here. This includes services such as WIC,
childcare centers, and training programs. Report all direct costs for staff, fringe benefits,
supplies, equipment depreciation, related travel and contracted services. (Staff for these
programs are reported on line 29a of Table 5.) Corporate administrative and facility costs
should be included on Line 15 Column A and allocated in Column B. Grantees are asked to
describe the program costs in the “specify” field provided.
TOTAL ENABLING AND OTHER PROGRAM RELATED SERVICES (Line 13) –
The sum of lines 11 + 12.
FACILITY AND ADMINISTRATIVE COSTS (Lines 14 - 16) — This includes all traditional overhead
costs that are later allocated to other cost centers. Specifically:
FACILITY COSTS (Line 14) – Facility costs include rent or depreciation, interest payments,
utilities, security, grounds keeping, facility maintenance and repairs, janitorial services, and all
other related costs.
ADMINISTRATIVE COSTS (Line 15) – Administrative costs include the cost of all corporate
administrative staff, billing and collections staff, medical records and intake staff, and the costs
associated with them including, but not limited to, supplies, equipment depreciation, travel, etc.
In addition, include other corporate costs (e.g., purchase of insurance, audits, legal fees,
October xx, 2010
71 1
interest payments on non-facility loans, Board of Directors' costs, etc.) The cost of all patient
support services (e.g., medical records and intake) should be included in Administrative Costs.
Note that the "cost" of bad debts is NOT to be included in administrative costs or shown on this
table in any way. Instead, the UDS reduces gross income by the amount of patient bad debt on
table 9D.
DRAFT
NOTE: Some grant programs have limitations on the proportion of grant funds that may be
used for administration. Limits on administrative costs for those programs is not to be
considered in completing lines 14 and 15. The Administration and Facility categories for this
report includes all administrative costs and personnel working in a BPHC-supported program,
whether or not that cost was identified as administrative in any specific grant application.
TOTAL OVERHEAD (Line 16) – The sum of lines 14 + 15.
TOTAL ACCRUED COST (Line 17) – It is the sum of lines 4 + 10 +13 + 16
VALUE OF DONATED FACILITIES, SERVICES AND SUPPLIES (Line 18) - Include here the total
imputed value of all in-kind and donated services, facilities and supplies applicable to the reporting
period that are within your scope of project, using the methodology discussed below. In-kind services
and donations include all services (generally volunteers, but sometimes paid staff donated to the grantee
by another organization), supplies, equipment, space, etc. that are necessary and prudent to the
operation of your program that you do not pay for directly and which you included in your budget as
donated. Line 18 reports the estimated reasonable acquisition cost of donated personnel, supplies,
services, space rental, and depreciation for the use of donated facilities and equipment. The value of
these services should not be included in the lines above.
The estimated reasonable acquisition cost should be calculated according to the cost that would be
required to obtain similar services, supplies, equipment or facilities within the immediate area at the
time of the donation. Donated pharmaceuticals, for example, would be shown at the price that
would be paid under the federal drug pricing program, not the manufacturer's suggested retail
price. Donated value should only be recognized when the intent of the donating parties is explicit
and when the services, supplies, etc., are both prudent and necessary to the grantee's operation.
If the grantee is not paying NHSC for assignees, the full market value of National Health Service
Corps (NHSC) Federal assignee(s), including "ready responders", should also be included in this
category. NHSC-furnished equipment, including dental operatories, should be capitalized at the
amount shown on the NHSC Equipment Inventory Document, and the appropriate depreciation
expense should be shown in this category for the reporting period.
Grantees are asked to describe the donated items using the “specify” field provided.
TOTAL WITH DONATIONS (LINE 19) – It is the sum of lines 17 and 18, Column C.
NOTE: As staff make up 70%+ of the cost of most health centers, there is a direct relationship between
the staffing included on Table 5 and expenses on Table 8A. Report as follows:
FTE’s reported on
Table 5, Line:
1 – 12: Medical (physicians, mid-level providers, nurses)
13-14: Lab and X-ray
16 – 18: Dental (e.g., dentists, dental hygienists, etc.)
20a – 20: Mental Health
October xx, 2010
Have costs reported on
Table 8A, Line:
1: Medical staff
2: Lab and X-ray
5: Dental
6: Mental Health
72 1
21: Substance Abuse
22: Other Professional (e.g. nutritionists, podiatrists, etc.)
22a-22d: Vision Services (ophthalmologist, optometrist, optometric
assistant
23: Pharmacy
24 – 28: Enabling (e.g., case management, outreach, eligibility,
etc.)
29a: Other programs / services (e.g., non-health related services
including WIC, job training, housing, child care, etc.)
30a – 30c and 32: Administration and Patient Support (e.g.,
corporate, intake, medical records, billing, fiscal and IT staff)
31: Facility (e.g., janitorial staff, etc.)
DRAFT
7: Substance Abuse
9: Other Professional
9: Other Professional
8a: Pharmacy
11a – 11g: Enabling
12: Other related
services
15: Administration
14: Facility
CONVERSION FROM FISCAL TO CALENDAR YEAR
Grantees whose cost allocation system permits them to provide accurate accrued cost data should use
that system. Grantees whose fiscal year does not correspond to the calendar year and whose
accounting system is unable to provide accurate accrued cost data may calculate calendar year
costs, using the following straight-line allocation methodology:
Step 1: Calculate the proportion of the calendar reporting period covered by the cost report and
use that ratio to calculate the proportion of cost in each category attributable to the calendar
year. Example: A grantee whose fiscal year ends March 31, 2010, allocates 25 percent of
costs in each cost category to the 2010 calendar year.
Step 2: Using the trial balance for the end of December, determine the total cost for the
remainder of the calendar year for each column. For example, a grantee whose fiscal year
ends March 31, 2010 would use the nine-month trial balance for December 31. (Note:
Grantees who do not accrue depreciation monthly should adjust depreciation to an annual
total.)
Step 3: Sum results of Steps 1 and 2 and enter the total in Column A.
October xx, 2010
73 1
Q UESTIONS
AND
A NSWERS
FOR
T ABLE 8A
DRAFT
1.
Are there any changes to this table?
There is one minor technical change for 2010. Prior to this year ophthalmologists were classified as
“other specialty physicians” and included in medical costs (on line 1). They are now in the “other
professional” cost center (line 9) and their direct and indirect costs should be moved here.
2.
My auditor says that the cost of bad debts must be reflected in my financial statement as a
cost. Where do I show it on Table 8A?
Your auditor is correctly explaining audit rules. The UDS report does not follow all FASBI and
GAAP accounting rules and this is one of those rules. Bad debt is not shown as a cost. Instead,
it is shown (accounted for) on Table 9D where it is viewed by BPHC as an adjustment to income.
3. How are donated services accounted for?
If an provider comes to your health center and renders a service to your patients, you show both
the FTE (on table 5) and the value, which is determined by "what a reasonable person would pay”
for the time – (not the service), on Table 8A, Line 18. For example, if an optometrist sees five
patients in a two hour period, the amount shown is what you would pay an optometrist for two
hours of work, not the total charges for the five visits. However, if you refer a patient for a service
to a provider outside of your site who donates these services neither the charge nor the value of
the time or service is reported on the UDS. For example, if you refer a patient to the county
hospital for a hip replacement which is provided to your patient at no cost to you or the patient,
neither the time of the surgical team nor the UCR charge for the service is reported on the UDS.
The same would be true of mammograms done at the County Health Department.
4. How are donated drugs accounted for?
If drugs are donated directly to the health center which then dispenses them to a patient, the value
of the drugs is calculated at what a reasonable payor would pay for them and is reported on Table
8A, Line 18. This is NOT the retail cost of the drug, it is the 340(b) price of the drug – an amount
which is generally 40% - 60% of the average wholesale price (AWP). Technically if the drug is
donated directly to the patient, even though it may be sent to the health center, this is not a
donation to the center and need not be accounted for or reported. But since we are interested in
knowing the total value of supplies provided to you directly or indirectly, grantees are encouraged
to include the value of such drugs on line 18 as well.
5. We get most of our vaccines through Vaccines For Children (VFC) or other state and county
programs. Are these considered to be donated drugs and accounted for here?
Yes. The value of donated drugs that are used in the clinic, such as vaccines, should also be
reported on Table 8A, Line 18, again at the reasonable cost.
6. What part of my ARRA grant is reported on Table 8A.
Table 8A reports on your total accrued costs including all costs supported by ARRA. But because
it is an accrual process, it will generally not include the cash outlays for capital expenses
supported by your ARRA CIP and/or FIP grants. It will include the 2010 depreciation on those
capital projects which have been placed in use, consistent with the health center’s usual
depreciation rules.
October xx, 2010
74 1
TABLE 8A – FINANCIAL COSTS
DRAFT
ACCRUED COST
ALLOCATION OF
FACILITY AND
ADMINISTRATION
(a)
(b)
TOTAL COST
AFTER
ALLOCATION OF
FACILITY AND
ADMINISTRATION
(c)
FINANCIAL COSTS FOR MEDICAL CARE
1.
Medical Staff
2.
Lab and X-ray
3.
Medical/Other Direct
TOTAL MEDICAL CARE SERVICES
4.
(SUM LINES 1 THROUGH 3)
FINANCIAL COSTS FOR OTHER CLINICAL SERVICES
5.
Dental
6.
Mental Health
7.
Substance Abuse
8a.
Pharmacy not including pharmaceuticals
8b.
Pharmaceuticals
9.
Other Professional (Specify ___________)
TOTAL OTHER CLINICAL SERVICES
10.
(SUM LINES 5 THROUGH 9)
FINANCIAL COSTS OF ENABLING AND OTHER PROGRAM RELATED SERVICES
11a.
Case Management
11b.
Transportation
11c.
Outreach
11d.
Patient and Community Education
11e.
Eligibility Assistance
11 f.
Interpretation Services
11g.
11.
12.
13.
Other Enabling Services (specify: ___________)
Total Enabling Services Cost
(Sum lines 11a through 11g)
Other Related Services (specify:________________)
TOTAL ENABLING AND OTHER SERVICES
(SUM LINES 11 AND 12)
Overhead and Totals
14.
Facility
15.
Administration
16.
TOTAL OVERHEAD
17.
TOTAL ACCRUED COSTS
18.
19.
(SUM LINES 14 AND 15)
(SUM LINES 4 + 10 + 13 + 16)
Value of Donated Facilities, Services and Supplies
(specify: _________________________)
TOTAL WITH DONATIONS
October xx, 2010
(SUM LINES 17 AND 18)
75 1
INSTRUCTIONS FOR TABLE 9D - PATIENT- RELATED REVENUE
DRAFT
Table 9D must be completed by all BPHC grantees covered by the UDS. It is included only in the
Universal Report. This table collects information on charges, collections, retroactive settlements,
allowances, self-pay sliding discounts, and self-pay bad debt write-off. The statute requires that all
health centers have a fee schedule and that they charge patients and/or their third party payors.
This does not preclude the center from discounting these fees (see discussion regarding Sliding
Discounts below, page 79) but there must be charges.
ROWS: PAYOR CATEGORIES AND FORM OF PAYMENT
Five payor categories are listed: Medicaid, Medicare, Other Public, Private, and Self Pay. Except for
Self Pay, each category has three sub-groupings: non-managed care, capitated managed care, and
fee-for-service managed care.
MEDICAID - LINES 1 - 3. Grantees should report as "Medicaid" all services billed to and paid for
by Medicaid (Title XIX) regardless of whether they are paid directly or through a fiscal intermediary
or an HMO. For example, in states with a capitated Medicaid program, where the grantee has a
contract with a private plan like Blue Cross, the payor is Medicaid, even though the actual payment
may have come from Blue Cross. Note that EPSDT (the childhood Early and Periodic Screening,
Diagnosis and Treatment program), which has various names in different states, is a part of Title
XIX and is included in the numbers reported here – almost always on line 1. Note also that CHIP
(or CHIP-RA), the Children's Health Insurance Program, which also has many different names in
different states, is sometimes paid through Medicaid. If this is the case, it should be included in
the numbers reported here. Also included here will be a portion of the charges for "cross-over"
services that are reclassified to Medicaid after being initially submitted to Medicare.
MEDICARE - LINES 4 - 6. Grantees should report as "Medicare" all services billed to and paid
for by Medicare (Title XVIII) regardless of whether they are paid directly or through a fiscal
intermediary or an HMO. Specifically, for patients enrolled in a capitated Medicare program,
including Medicare Advantage, where the grantee has a contract with a private plan like Blue
Cross, the payor is Medicare, even though the actual payment may have come from Blue Cross. If
a patient is covered by both Medicare and Medicaid, or by Medicare and a private payor, some
portion of the charge will be reclassified to these other payment sources, and patient co-payments
will be reclassified to “self pay”.
OTHER PUBLIC - LINES 7 - 9. Grantees should report as "Other Public" all services billed to
and paid for by State or local governments through programs other than indigent care programs.
The most common of these would be CHIP, the Children's Health Insurance Program, which has
many different names in different states, when it is paid for through commercial carriers. (See
above if CHIP is paid through Medicaid.) Other Public also includes family planning programs,
BCCCP (Breast and Cervical Cancer Control Programs with various state names,) and other
dedicated state or local programs as well as state insurance plans, such as Washington's Basic
Health Plan or Massachusetts' Commonwealth Plan. Other Public does not include state or
local indigent care programs. Patients whose only payment source is one of these other public
programs are reported as "uninsured" on Table 4.
NOTE. Reporting on state or local indigent care programs that subsidize services rendered to
the uninsured is as follows:
• Report all charges for these services and collections from patients as "self-pay" (line 13
columns a and b of this table);
October xx, 2010
76 1
•
Report all amounts not collected from the patients as sliding discounts or bad debt writeoff, as appropriate, on line 13 columns e and f of this table; and
Report collections from the associated state and local indigent care programs on Table
9E and specify the program paying for the services. State/local indigent care programs
are reported on line 6a on that table.
DRAFT
•
Do not classify anything as an indigent care program without first reviewing this in a UDS
Training Program or with the UDS Help line.
PRIVATE- LINES 10 - 12. Grantees should report as "Private" all services billed to and paid for
by commercial insurance companies or by other third party payors. Specifically, do not include
any services that fall into one of the other categories. As noted above, charges etc. for Medicaid,
Medicare and CHIP programs which use commercial programs as intermediaries are classified
elsewhere. Private insurance includes insurance purchased for public employees or retirees such
as Tricare, Trigon, the Federal Employees Insurance Program, Workers Compensation, etc.
Private may also include contract payments from other organizations who engage the clinic on a
fee-for-service or other reimbursement basis such as a Head Start program that pays for annual
physical exams at a contracted rate, or a school, jail or large company that pays for provision of
medical care at a per-session or negotiated rate.
SELF PAY - LINE 13. Grantees should report as "Self Pay" all services and charges where the
responsible party is the patient, including charges for indigent care programs as discussed above
under “other public”. NOTE: This includes the reclassified co-payments, deductibles, and
charges for uncovered services for otherwise insured individuals which become the
patient's personal responsibility.
COLUMNS: CHARGES, PAYMENTS, AND ADJUSTMENTS RELATED TO SERVICES
DELIVERED (REPORTED ON A CASH BASIS.)
FULL CHARGES THIS PERIOD (Column a) – Record in Column A the total charges for each
payor source. This should always reflect the full charge (per the fee schedule) for services
rendered to patients in that payor category. Charges should only be recorded for services that are
billed to AND covered in whole or in part by a payor, or the patient, even if some of the latter are
written off with sliding discounts. Full gross charges should always be reported. The difference
between these and contracted payments are then adjusted as “contractual allowances” (see
below.) Some patients have more than one source of payment for their services. In these
instances, a charge will initially be made to one carrier, who may deny or pay only in part. The
unpaid portion will then be moved to the secondary payor, and to a tertiary payor if one exists and,
eventually, to the patient as a self-pay charge.
Charges that are generally not billable or covered by traditional third-party payors should not be
included on this table. For example, a charge for parking or for job training would not normally be
included. WIC services are not billable charges. Charges for transportation and similar enabling
services would not generally be included in Column A, except where the payor (e.g., Medicaid)
accepts billing and pays for these services.
Charges for eyeglasses, pharmaceuticals, durable medical equipment and other similar
supply items must be included. Charges for pharmaceuticals, including vaccines, which are
donated to the clinic or directly to a patient through the clinic should not be included since
the clinic may not legally charge for these drugs. Charges for dispensing these
pharmaceuticals, may, however, be included.
October xx, 2010
77 1
Charges which are not accepted by a payor and which need to be reclassified (including
deductibles and co-insurance) should be reversed as negative charges if your MIS system does
not reclassify them automatically. Reclassifying these charges by utilizing an adjustment and
rebilling to another category is an incorrect procedure since it will result in overstatement by
includingthe charges twice as well as the adjustments and payments.
DRAFT
NOTE: Under no circumstances should the actual amount paid by Medicaid or Medicare
(such as FQHC rates) or the amount paid by any other payor be used as the actual charges.
Charges must come from the grantee's CPT based fee schedule.
AMOUNT COLLECTED THIS PERIOD (Column b) — Record in Column b the gross receipts for
the year on a cash basis, regardless of the period in which the paid for services were rendered.
This includes the FQHC reconciliations, managed care pool distributions, court settlements, and
other payments recorded in columns c1, c2, c3,and/or c4. Note: Charges and collections for
deductibles and co-payments which are charged to, paid by, and/or due from patients are recorded
as “self pay” on Line 13.
RETROACTIVE SETTLEMENTS, RECEIPTS, OR PAYBACKS (Column c) — IN ADDITION TO
INCLUDING THEM IN COLUMN b, details on cash receipts or payments for FQHC reconciliation,
managed care pool distributions, payments from managed care withholds, and paybacks to FQHC or
HMOs are reported in Columns c1 - c4.
COLLECTION OF RECONCILIATION/WRAP AROUND, CURRENT YEAR (Column c1) Enter
FQHC cash receipts from Medicare and Medicaid that cover services provided during the current
reporting period.
COLLECTION OF RECONCILIATION/WRAP AROUND, PREVIOUS YEARS (Column c2)
Enter FQHC cash receipts from Medicare and Medicaid that cover services provided during
previous reporting periods. Include multi-year settlements here.
COLLECTION OF OTHER RETROACTIVE PAYMENTS INCLUDING RISK
POOL/INCENTIVE/WITHHOLD (Column c3) Enter other cash payments including managed
care risk pool redistribution, incentives, and withholds, from any payor. These payments are only
applicable to managed care plans. Include as well settlements which may result from a court
decision which requires a payor to make a settlement including a multi-year settlement.
PENALTY/PAYBACK (Column c4) – Enter payments made to FQHC payors because of
overpayments collected earlier. Also enter “penalty” payments made to managed care plans for
over-utilization of the inpatient or specialty pool funds. (This is now a rare occurrence.)
NOTE: If a center arranges to have their "repayment" deducted from their monthly
payment checks, the amount deducted should be shown in Column (c4) as if it had
actually been paid in cash during the year and should be added to the amount
received in column b.
ALLOWANCES (Column d) – Allowances are granted as part of an agreement with a third-party
payor. Virtually all insurance companies, for example, have a maximum amount they pay, and the
center agrees to write off the difference between what they charge and what they receive. These
amounts are reported in column d. Allowances must be reduced by the net amount of retroactive
settlements and receipts reported in the columns c1. c2, c3, c4, including current and prior year
FQHC reconciliations, managed care pool distributions and other payments. This will often result in
a negative number being reported as the allowance in Column d.
October xx, 2010
78 1
DRAFT
If, as a result of a contract or agreement, Medicaid, Medicare, other third-parties, or other public payors
reimburse less than the grantee's full charge, and the grantee cannot bill the patient for the remainder,
the remainder or reduction on the appropriate payor line is entered in Column d at the time the
Explanation of Benefits (EOB) is received and the amount is written off.
Example: The State Title XIX Agency has paid $40 for an office visit that was billed at a full
charge of $75. The $75 should be reported on Line 1 Column a as a full charge to Medicaid. After
payment was made, the $40 payment is recorded on Line 1 Column b. The $35 reduction is
reported as a positive allowance (+$35) on Line 1 Column d.
Under FQHC programs, where the grantee is paid based on cost, it is possible that the cash
payment will be greater than the charge. In this case, the adjustment recorded in Column D would
be a negative adjustment. (Financial adjustments received under FQHC are reported in Columns c1
and c2)
Example: The State Title XIX Agency has paid grantee’s negotiated FQHC rate of $113 for an
office visit that was billed at a full charge of $75. The $75 should be reported on Line 1 Column A
as a full charge to Medicaid. After payment was made, the $113 payment is recorded on Line 1
Column b. The $38 payment over the actual charge is reported as a negative allowance (-$38)
on Line 1 Column D.
NOTE: Amounts for which another third party or a private individual can be billed (e.g., amounts due
from patients or "Medigap" payors for co-payments) are not considered adjustments and should be
recorded or reclassified as full charges due from the secondary source of payment. These amounts
will only be classified as adjustments when all sources of payment have been exhausted and further
collection is not anticipated and/or possible.
Because capitated plans typically pay on a per-member per-month basis only, and make this
payment in the current month of enrollment, these plans typically don't carry any receivables. For
Capitated Plans (lines 2a, 5a, 8a, and 11a, ONLY) the allowance column should be the arithmetic
difference between the charge recorded in Column a and the collection in Column b unless there
were early or late capitation payments (received in a month other than when they were earned) and
which span the beginning or end of the calendar year.
Also note that Line 13 Column d is blanked out because up-front allowances given to selfpay patients are recorded as sliding discounts and valid self-pay receivables that are not
paid should be recorded as self pay bad debt.
SLIDING DISCOUNTS (Column e) – In this column, enter reductions to patient charges based on the
patient's ability to pay, as determined by the grantee's sliding discount schedule. This would include
discounts to required co-payments, as applicable.
NOTE: Only self-pay patients may be granted a sliding discount based on their ability to pay.
Column e is blanked out on all other lines. When a charge originally made to a third party such as
Medicare or a private insurance company has a co-payment or deductible written off, THE
CHARGE MUST FIRST BE RECLASSIFIED TO SELF-PAY. To reclassify, first reduce the thirdparty charge by the amount due from the patient and increase the self-pay charges by this same
amount.
BAD DEBT WRITE OFF (Column f) – Any payor responsible for a bill may default on a payment due
from it. In the UDS, only self pay bad debts are recorded. In order to keep responsible financial
records, centers are required to write off bad debts on a routine basis. (It is recommended that this be
October xx, 2010
79 1
done no less than annually). In some systems this is accomplished by posting an allowance for bad
debts rather than actually writing off specific named accounts. Amounts removed from the center's
self-pay receivables through either (but not both) mechanism are recorded here.
DRAFT
Reductions to the collectable amount for the Self-Pay category based on the patient’s income
and family size should be made on Line 13 column f. Bad debt write off may occur due to the
grantee's inability to locate persons, a patient's refusal to pay, or a patient's inability to pay even
after the sliding fee discount is granted.
Under no circumstances are bad debts to be reclassified as sliding discounts, even if the write
off to bad debt is occasioned by a patient's inability to pay the remaining amount due. For
example, a patient eligible for a sliding discount is supposed to pay 50 percent of full charges
for a visit. If the patient does not pay, even if he or she later qualifies for a 100 percent
discount, the amount written off must still be reported as bad debt, not sliding discount. At the
time of the visit, it was a valid collectable from the patient.
Only bad-debts from patients are recorded on this table. While some insurance companies do, in
fact, default on legitimate debts as they go bankrupt, centers are not asked to report these data.
TOTAL PATIENT RELATED INCOME (Line 14) — Enter the sum of Lines 3, 6, 9, 12, and 13. Be
sure to include only these "subtotal" lines and not the detail for each of the subtotals.
October xx, 2010
80 1
QUESTIONS AND ANSWERS FOR TABLE 9D
DRAFT
1. Are there any changes to this table?
Beginning in 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) added
requirements for managed care programs to reconcile payments to cost similar to FQHC for
Medicaid. As a result, columns c1 and c2 have been opened up on lines 7 – 9. These cells are to
be used for CHIPRA adjustments only.
2. How are charges to an indigent care program handled?
Payments received from state or local indigent care programs subsidizing services
rendered to the uninsured are not reported on this table. All such payments, whether made
on a per visit basis or as a lump sum for services rendered, shall be recorded on Table 9E, Line 6a.
See Table 9E for specific instructions. Grantees receiving payments from state/local indigent care
programs that subsidize services rendered to the uninsured should:
•
•
•
Report all charges for these services and collections from patients as "self-pay" (Line
13);
Report all amounts not collected from the patient as sliding discounts or bad debt, as
appropriate, on Line 13 of this table;
Report collections from the state/local indigent care programs on Table 9E, Line 6a.
3. Are the data on this table cash or accrual based?
Table 9D is essentially a “cash” table. Entries represent gross charges and adjustments for the
reporting calendar year and actual cash receipts for the year.
4. Should the lines of the table "balance"?
No. Because the table is on a “cash” basis, the columns for amount collected and for allowances
will include payments and adjustments for services rendered in the prior year. Conversely, some of
the charges for the current year will be remaining in accounts receivable at the end of the year.
The one exception is on the capitated lines (lines 2a, 5a, 8a, and 11a) where allowances are the
difference between charges and collections by definition, provided there are no early or late
capitation payments that cross the calendar year change.
5. If we have not received any reconciliation payments for the reporting period what do we
show in Column c1 (current year reconciliations)?
If you have not received a payment during this reporting period for current year services, enter
zero (0) in Column c1.
6. We regularly apply our sliding discount program to write off the deductible portion of the
Medicare charge for our certified low-income patients. The sliding discount column
(Column e) is blanked out for Medicare. How do we record this write off?
The amount of the deductible needs to be removed from the charge column of the Medicare line
(Lines 4 - 6 as appropriate) and then added into the self-pay line (Line 13). It can then be written
off on Line 13. The same process would be used for any other co-payment or deductible write-off.
7. Our system does not automatically reclassify amounts due from other carriers or from the
patient. Must we, for example, reclassify Medicare charges that become co-payments or
Medicaid charges?
Yes – regardless of whether or not it is done automatically by your PMS the UDS report must
reflect this reclassification of all charges that end up being the responsibility of a party other than
the initial party.
October xx, 2010
81 1
DRAFT
TABLE 9D (Part I of II) –PATIENT RELATED REVENUE (Scope of Project Only)
FULL
CHARGES
THIS
PERIOD
PAYOR CATEGORY
1.
Medicaid Non-Managed
Care
2a.
Medicaid Managed Care
(capitated)
2b.
Medicaid Managed Care
(fee-for-service)
3.
(a)
AMOUNT
COLLECTED
THIS
PERIOD
(b)
RETROACTIVE SETTLEMENTS, RECEIPTS, AND PAYBACKS (c)
COLLECTION OF
COLLECTION OF
RECONCILIATIO
N/WRAP
RECONCILIATION
/WRAP AROUND
CURRENT YEAR
AROUND
PREVIOUS
YEARS
(c1)
(c2)
ALLOWANCES
COLLECTION OF
OTHER
RETROACTIVE
PAYMENTS
INCLUDING RISK
POOL/
INCENTIVE/
WITHHOLD
PENALTY/
PAYBACK
(c3)
(c4)
TOTAL MEDICAID
(LINES 1+ 2A + 2B)
4.
Medicare Non-Managed
Care
5a.
Medicare Managed Care
(capitated)
5b.
Medicare Managed Care
(fee-for-service)
6.
TOTAL MEDICARE
(LINES 4 + 5A+ 5B)
7.
Other Public including
Non-Medicaid CHIP (Non
Managed Care)
8a.
Other Public including
Non-Medicaid CHIP
(Managed Care Capitated)
October xx, 2010
82
(d)
SLIDING
DISCOUNTS
BAD DEBT
WRITE OFF
(e)
(f)
DRAFT
TABLE 9D (Part II of II) –PATIENT RELATED REVENUE (Scope of Project Only)
RETROACTIVE SETTLEMENTS, RECEIPTS, AND PAYBACKS (c)
Full
Charges
This
Period
AMOUNT
COLLECTED
THIS
PERIOD
COLLECTION OF
COLLECTION OF
RECONCILIATION/
RECONCILIATION
/WRAP AROUND
CURRENT YEAR
WRAP AROUND
PREVIOUS YEARS
(c1)
(c2)
PAYOR CATEGORY
(a)
8b.
9.
11a.
Private Managed Care
(capitated)
11b.
Private Managed Care
(fee-for-service)
14.
(c4)
(c3)
TOTAL OTHER PUBLIC
(LINES 7+ 8A +8B)
Private Non-Managed
Care
13.
OTHER
RETROACTIVE
PAYMENTS
INCLUDING RISK
POOL/ INCENTIVE/
WITHHOLD
PENALTY/
PAYBACK
Other Public including
Non-Medicaid CHIP
(Managed Care fee-forservice)
10.
12.
(b)
COLLECTION OF
TOTAL PRIVATE
(LINES 10 + 11A + 11B)
Self Pay
TOTAL
(LINES 3 + 6 + 9 + 12 + 13)
October xx, 2010
83
ALLOWANCES
(d)
DISCOUNTS
BAD DEBT
WRITE
OFF
(e)
(f)
SLIDING
INSTRUCTIONS FOR TABLE 9E - OTHER REVENUE
DRAFT
Table 9E must be completed by all BPHC grantees covered by the UDS. It is included only in the
Universal Report. This table collects information on cash receipts for the reporting period that
supported activities described in the scope of project(s) covered by any of the four BPHC grant
programs. Income received during the reporting period means cash receipts received during the
calendar year for a Federally-approved project even if the revenue was accrued during the previous
year or was received in advance and considered "unearned revenue" in the center's books on
December 31.
The UDS uses the “last party rule” to report grant revenues. The “last party rule” means that
GRANT AND CONTRACT FUNDS SHOULD ALWAYS BE REPORTED BASED ON THE ENTITY
FROM WHICH THE GRANTEE RECEIVED THEM, REGARDLESS OF THEIR ORIGINAL ORIGIN.
For example, funds awarded by the state for maternal and child health services usually include a
mixture of Federal funds such as Title V and State funds. These should be reported as State grants
because they are awarded by the state. Similarly, WIC funds are totally provided by the Federal
Department of Agricultural, but are always passed through the State, and are reported on Line 6.
BPHC GRANTS
LINES 1 a THROUGH LINE 1e – Enter draw-downs during the reporting period for all BPHC
Section 330 grants in the primary care cluster. (Do not include ARRA funds on these lines.)
These include the four primary care programs included in the UDS. Note that lines 1 d and 1 f
no longer are reported. Amounts should be consistent with the PMS-272 report.
TOTAL HEALTH CENTER CLUSTER (Line 1g) – Enter the total of Lines 1 a through 1e.
CAPITAL IMPROVEMENT PROGRAM GRANTS (Line 1j) – Enter the amount of Capital
Improvement Program grant dollars drawn down. This is a legacy program which is all but
extinct at this time. Do not use this line unless you are certain you have some of these funds.
DO NOT INCLUDE ARRA CAPITAL IMPROVEMENT GRANTS ON THIS LINE. They are to
be reported on line 4a.
TOTAL BPHC GRANTS (Line 1) – Enter the total of Lines 1g (Total Health Center Cluster),
and 1j (non-ARRA Capital Improvement Program Grants). Be sure that all BPHC Section 330
grant funds drawn down during the year are included on line 1. The amounts shown on the
BPHC Grant Lines should reflect direct funding only. They should not include BPHC funds
passed through to you from another BPHC grantee nor should they be reduced by money that
you passed through to other centers. Note again that ARRA funds are not 330 funds and ARE
included only on line 4 and 4a as discussed below.
OTHER FEDERAL GRANTS
RYAN WHITE Part C HIV EARLY INTERVENTION (Line 2) — Enter the amount of the
Ryan White Part C funds drawn down in the reporting period. NOTE: Ryan White Part A,
Impacted Area, grants come from County or City governments and are reported on Line 7
(unless they are first sent to a third party in which case the funds are reported on Line 8.)
Part B grants come from the state and are reported on Line 6, unless they are first sent to a
County or City government (in which case they are reported on Line 7) or to a third party (in
October xx, 2010
84 1
which case the funds are reported on Line 8.) SPRANS grants are generally direct Federal
grants, and are reported on line 3.
DRAFT
OTHER FEDERAL GRANTS (Line 3) – Enter the amount and source of any other Federal grant
revenue received during the reporting period which falls within the scope of the project(s).
These grants include only those funds received directly by the center from the U.S. Treasury.
Do not include Federal funds which are first received by a State or Local government or other
agency and then passed on to the grantee such as WIC or Part B or Part C Ryan White funds.
These are included below on Lines 6 through 8. Grantees are asked to describe the programs
so the UDS reviewer can make sure that the classification of the program as a federal grant is
appropriate.
ARRA NAP, IDS, CIP and FIP GRANT FUNDS (Lines 4 and 4a) – Enter the amount of
American Recovery and Reinvestment Act (ARRA) New Access Point and/or Increased
Demand for Services (IDS) grant funds which were drawn down in 2010 on line 4. Enter the
amount of ARRA Capital Improvement and/or Facility Investment grant funds which were
drawn down in 2010 on line 4a. Note that ARRA grants were given for a multi-year period. It is
not expected that the amount reported will equal the amount awarded. Please review your
PMS 272 forms to determine the draw-down amount.
TOTAL OTHER FEDERAL GRANTS (Line 5) — Enter the total of Line 2 + Line 3 + Line 4 +
Line 4a.
NON-FEDERAL GRANTS OR CONTRACTS
STATE GOVERNMENT GRANTS AND CONTRACTS (Line 6) — Enter the amount of funds
received under State government grants or contracts. "Grants and Contracts" are defined as
amounts received on a line item or other basis which are not tied to the delivery of services.
They do NOT include funds from state indigent care programs. When a state grant or contract
other than an indigent care program pays a grantee based on the amount of health care
services provided or on a negotiated fee for service or fee per visit, the charges, collections
and allowances are reported on Table 9D as "Other Public" services, not here on Table 9E.
Grantees are asked to describe the programs so the UDS editor can make sure that the
classification of the program as a state grant is appropriate.
STATE/LOCAL INDIGENT CARE PROGRAMS (Line 6a) – Enter the amount of funds received
from state/local indigent care programs that subsidize services rendered to the uninsured
(examples include Massachusetts Free Care Pool, New Jersey Uncompensated Care
Program, NY Public Goods Pool Funding, California Expanded Access to Primary Care
Program, Tobacco Tax programs in Arizona and New Mexico, and the Colorado Indigent
Care Program). Grantees are asked to describe the programs so the UDS editor can make
sure that the classification of the program as a state/local indigent care program is
appropriate.
NOTE: Payments received from state or local indigent care programs subsidizing
services rendered to the uninsured should be reported on Line 6a of this table whether
on not the actual payment to the grantee is made on a per visit basis or as a lump
sum for services rendered. Patients covered by these programs are reported as
uninsured on Table 4 and all of their charges, sliding discounts, and bad debt writeoffs are reported on the self-pay line (line 13) on Table 9D. Monies collected from the
patients covered by indigent programs should be reported on 9D. However, none of
the funds reported on Line 6a of Table 9E are to be reported on Table 9D.
October xx, 2010
85 1
LOCAL GOVERNMENT GRANTS AND CONTRACTS (Line 7) — Report the amount received
from local governments during the reporting period that covers costs included in the scope of
the grantee's project(s). "Grants and Contracts" are defined as amounts received on a line
item or other basis which are not tied to the delivery of services. They do NOT include funds
from local indigent care programs. When a local grant or contract other than an indigent care
program pays a grantee based on the amount of health care services provided or on a
negotiated fee for service or fee per visit, the charges, collections and allowances are
reported on Table 9D as "Other Public" services, not here on Table 9E. Grantees are asked
to describe the programs so the UDS editor can make sure that the classification of the
program as a local grant is appropriate.
DRAFT
FOUNDATION / PRIVATE GRANTS AND CONTRACTS (Line 8) – Report the amount
received during the reporting period that covers costs included within the scope of the
project(s). Funds which are transferred from another grantee or another community service
provider are considered "private grants and contracts" and included on this line. Grantees are
asked to describe the programs so the UDS editor can make sure that the classification of the
program as a foundation/private grant is appropriate.
TOTAL NON-FEDERAL GRANTS AND CONTRACTS (Line 9) – Enter the total of Lines 6,
6a, 7, and 8.
OTHER REVENUE (Line 10) – Other Revenue refers to other receipts included in the
federally approved scope of project that are not related to charge-based services. This may
include fund-raising, interest income, rent from tenants, etc. Grantees are asked to describe
these sources of "other revenue". Do NOT enter the value of in-kind or other donations made
to the grantee – these are shown only on Table 8A, line 18. Also, DO NOT show the proceeds
of any loan received, either for operations or in the form of a mortgage.
TOTAL REVENUE (Line 11) – Enter the total of Lines 1, 5, 9, and 10 for total other
revenues / income.
October xx, 2010
86 1
DRAFT
QUESTIONS AND ANSWERS FOR TABLE 9E
1. Are there any changes to this table?
No.
2. Are there any important issues to keep in mind for this table?
This table collects information on cash receipts for the reporting period that supported activities
described in the scope of project covered by any of the four BPHC grant programs. Only cash
receipts received during the calendar year should be reported. In the case of a grant, this amount
equals the cash amount received during the year not the full award amount unless the full award
was paid during the year.
3. How should indigent care funds be reported on the UDS?
Payments received from state or local indigent care programs subsidizing services rendered to the
uninsured should be reported on Line 6a of Table 9E whether on not the actual payment to the
grantee is made on a per visit or visit basis or as a lump sum for services rendered. Patients
covered by these programs are reported as uninsured on Table 4 and all of their charges,
sliding discounts, and bad debt write-offs are reported on the self-pay line (line 13) on Table 9D.
Monies collected from the patients covered by indigent programs should be reported on 9D.
However, none of the funds reported on Line 6a of Table 9E are to be reported on Table 9D.
October xx, 2010
87 1
TABLE 9E –OTHER REVENUES
DRAFT
SOURCE
AMOUNT
(a)
BPHC GRANTS (ENTER AMOUNT DRAWN DOWN - CONSISTENT WITH PMS-272)
1a.
Migrant Health Center
1b.
Community Health Center
1c.
Health Care for the Homeless
1e.
Public Housing Primary Care
1g.
TOTAL HEALTH CENTER CLUSTER (SUM LINES 1A THROUGH 1E)
1j.
Capital Improvement Program Grants (excluding ARRA)
TOTAL BPHC GRANTS (SUM LINES 1G + 1J)
1.
OTHER FEDERAL GRANTS
2.
Ryan White Part C HIV Early Intervention
3.
Other Federal Grants (specify:________________)
4.
4a
American Recovery and Reinvestment Act (ARRA) New Access
Point (NAP) and Increased Demand for Services (IDS)
American Recovery and Reinvestment Act (ARRA) Capital
Improvement Project (CIP) and Facility Investment Program (FIP)
TOTAL OTHER FEDERAL GRANTS (SUM LINES 2 – 4A)
5.
NON-FEDERAL GRANTS OR CONTRACTS
6.
State Government Grants and Contracts (specify:______________)
6a.
State/Local Indigent Care Programs (specify:________________)
7.
Local Government Grants and Contracts (specify:_______________)
8.
Foundation/Private Grants and Contracts(specify:_______________)
90.
TOTAL NON-FEDERAL GRANTS AND CONTRACTS
(SUM LINES 6 + 6A+7+8)
Other Revenue (Non-patient related revenue not reported elsewhere)
(specify:________________)
10.
11.
October xx, 2010
TOTAL REVENUE (LINES 1+5+9+10)
88 1
DRAFT
APPENDIX A: LISTING OF PERSONNEL
(ALL Line numbers in the following table refer to Table 5)
PERSONNEL BY MAJOR SERVICE CATEGORY
PROVIDER
NON-PROVIDER
PHYSICIANS
•
Family Practitioners (Line 1)
X
•
General Practitioners (Line 2)
X
•
Internists (Line 3)
X
•
Obstetrician/Gynecologists (Line 4)
X
•
Pediatrician (Line 5)
X
OTHER SPECIALIST PHYSICIANS (Line 7)
•
Allergists
X
•
Cardiologists
X
•
Dermatologists
X
•
Orthopedists
X
•
Surgeons
X
•
Urologists
X
•
Other Specialists And Sub-Specialists
X
NURSE PRACTITIONERS (Line 9a)
PHYSICIANS ASSISTANTS (Line 9b)
CERTIFIED NURSE MIDWIVES (Line 10)
NURSES (Line 11)
X
X
X
•
Clinical Nurse Specialists
X
•
Public Health Nurses
X
•
Home Health Nurses
X
•
Visiting Nurses
X
•
Registered Nurse
X
•
Licensed Practical Or Vocational Nurse
X
OTHER MEDICAL PERSONNEL (Line 12)
•
Nurse Aide/Assistant (Certified And Uncertified)
X
•
Clinic Aide/Medical Assistant (Certified And Uncertified
Medical Technologists)
X
•
Quality Assurance / EHR design staff
LABORATORY PERSONNEL (Line 13)
•
Pathologists
X
•
Medical Technologists
X
•
Laboratory Technicians
X
•
Laboratory Assistants
X
•
Phlebotomists
X
X-RAY PERSONNEL (Line 14)
•
Radiologists
October xx, 2010
X
89 1
PERSONNEL BY MAJOR SERVICE CATEGORY
DRAFT
PROVIDER
NON-PROVIDER
•
X-Ray Technologists
X
•
X-Ray Technician
X
DENTISTS (Line 16)
•
General Practitioners
X
•
Oral Surgeons
X
•
Periodontists
X
•
Endodontists
X
OTHER DENTAL
•
Dental Hygienists (Line 17)
•
Dental Assistant (Line 18)
X
•
Dental Technician (Line 18)
X
•
Dental Aide (Line 18)
X
X
MENTAL HEALTH (Line 20) & SUBSTANCE ABUSE (Line 21)
•
Psychiatrists (Line 20a)
X
•
Psychologists (Line 20a1)
X
•
Social Workers - Clinical (Line 20a2 or 21)
X
•
Social Workers - Psychiatric (Line 20b or 21)
X
•
Family Therapists (Line 20b or 21)
X
•
Nurses - Psychiatric And Mental Health (Line 20b)
X
•
Alcohol And Drug Abuse Counselors (Line 21)
X
•
Nurse Counselor (Line 20b)
X
ALL OTHER PROFESSIONAL PERSONNEL (Line 22)
•
Audiologists
X
•
Acupuncturists
X
•
Chiropractors
X
•
Herbalists
X
•
Massage Therapists
X
•
Naturopaths
X
•
Occupational Therapists
X
•
Optometrists
X
•
Podiatrists
X
•
Physical Therapists
X
•
Respiratory Therapists
X
•
Speech Therapists / Pathologists
X
•
Traditional Healers
X
•
Nutritionists/Dietitians
X
VISION SERVICES PERSONNEL (Line 22a-22d)
•
Ophthalmologists (line 22a)
X
•
Optometrists (line 22b)
X
October xx, 2010
90 1
PERSONNEL BY MAJOR SERVICE CATEGORY
DRAFT
•
PROVIDER
Optometric Assistant (line 22c)
NON-PROVIDER
X
PHARMACY PERSONNEL (Line 23)
•
Pharmacist, Clinical Pharmacist
X
•
Pharmacist Assistant
X
•
Pharmacy Clerk
X
ENABLING SERVICES
CASE MANAGERS (Line 24)
•
Case Managers
X
•
Care / Referral Coordinators
X
•
Social Workers
X
•
Public Health Nurses
X
•
Home Health Nurses
X
•
Visiting Nurses
X
•
Registered Nurses
X
•
Licensed Practical Nurses
X
HEALTH EDUCATORS (Line 25)
•
Family Planning Counselors
X
•
Health Educators
X
•
Social Workers
X
•
Public Health Nurses
X
•
Home Health Nurses
X
•
Visiting Nurses
X
•
Registered Nurses
X
•
Licensed Practical Nurses
X
OUTREACH WORKERS (Line 26)
X
PATIENT TRANSPORTATION WORKERS (Line 27)
•
Patient Transportation Coordinator
X
•
Driver
X
E LIGIBLITY ASSISTANCE WORKERS (Line 27a)
•
Benefits Assistance Workers
X
•
Eligibility Workers
X
•
Registration Clerks
X
INTERPRETATION (Line 27b)
•
Interpreters
X
•
Translators
X
OTHER ENABLING SERVICES PERSONNEL (LINE 28)
X
OTHER RELATED SERVICES STAFF (Line 29a)
•
WIC Workers
October xx, 2010
X
91 1
PERSONNEL BY MAJOR SERVICE CATEGORY
DRAFT
PROVIDER
NON-PROVIDER
•
Head Start Workers
X
•
Housing Assistance Workers
X
•
Child Care Workers
X
•
Food Bank / Meal Delivery Workers
X
•
Employment / Educational Counselors
X
MANAGEMENT AND SUPPORT STAFF (Line 30a)
•
Project Director
X
•
Chief Executive Officer/ Executive Director
X
•
Chief Financial Officer
X
•
Chief Information Officer
X
•
Chief Medical Officer
X
•
Secretary
X
•
Administrator
X
•
Director of Planning And Evaluation
X
•
Clerk Typist
X
•
Personnel Director
X
•
Receptionist
X
•
Director of Marketing
X
•
Marketing Representative
X
•
Enrollment/Service Representative
X
FISCAL AND BILLING STAFF (Line 30b)
•
Finance Director
X
•
Accountant
X
•
Bookkeeper
X
•
Billing Clerk
X
•
Cashier
X
•
Data Entry Clerk
X
IT STAFF (Line 30c)
•
Director of Data Processing
X
•
Programmer
X
•
IT Help Technician
X
•
Data Entry Clerk
X
FACILITY (Line 31)
•
Janitor/Custodian
X
•
Security Guard
X
•
Groundskeeper
X
October xx, 2010
92 1
PERSONNEL BY MAJOR SERVICE CATEGORY
DRAFT
PROVIDER
NON-PROVIDER
•
Equipment Maintenance Personnel
X
•
Housekeeping Personnel
X
PATIENT SERVICES SUPPORT STAFF (Line 32)
•
Medical And Dental Team Clerks
X
•
Medical And Dental Team Secretaries
X
•
Medical And Dental Appointment Clerks
X
•
Medical And Dental Patient Records Clerks
X
•
Patient Records Supervisor
X
•
Patient Records Technician
X
•
Patient Records Clerk
X
•
Patient Records Transcriptionist
X
•
Registration Clerk
X
•
Appointments Clerk
X
October xx, 2010
93 1
APPENDIX B: SPECIAL MULTI-TABLE SITUATIONS
DRAFT
Several conditions require special consideration in the UDS because they impact multiple
tables which must then be reconciled to each other. Beginning with this tenth edition of the
UDS manual, we will be presenting some of these special situations along with instructions on
how to deal with them. In this edition, we deal with the following issues:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Contracted care (specialty, dental, mental health, etc.) which is paid for by the
reporting grantee
Services provided by a volunteer provider
Interns and Residents
WIC
In-house pharmacy or dispensary services for grantee’s patients
In-house pharmacy for community (i.e., for non-patients)
Contract pharmacies
Donated drugs
Clinical dispensing of drugs
Adult Day Health Care (ADHC)
Medi-Medi cross-overs
Certain grant supported clinical care programs (BCCCP, Title X, etc.)
State or local safety net programs
Workers Compensation
Tricare, Trigon, Public Employees Insurance, etc.
Contract sites
CHIP
Carved-out services
Migrant voucher programs and other voucher programs
Incarcerated patients
October xx, 2010
94 1
ISSUE
DRAFT
TABLES
AFFECTED
TREATMENT
Providers (Column A) are counted if the contract is for a portion of an FTE (e.g., one day a
week OB = 0.20 FTE). Providers are not counted if contract is for a service (e.g., $X per visit or
5
$55 per RBRVU). Visits (Column B) are always counted, regardless of method of provider
payment or location of service (grantee’s site or contract provider’s office.)
Grantee receives encounter form or equivalent from contract provider, counts primary diagnosis
6
and/or services provided as applicable.
Contracted Care
Column A: Net Cost.
Cost of provider/service is reported on applicable line.
(Specialty, dental,
8A
Column
B:
Overhead.
Grantee will generally use a lower “overhead rate” for off-site
mental health, etc.)
services.
(Service must be paid
Charge (Column A) is grantee’s UCR charge if on-site; is contractor’s UCR charge if off site.
for by grantee!)
Collection (Column B) is the amount received by either grantee or contractor from first or third
parties.
9D
Allowance (column D) is amount disallowed by a third party for the charge (if on lines 1 – 12)
Sliding Discount (column E) is amount written off for eligible patients per center’s fiscal
policies (line 13). Calculated as UCR charge minus amount collected from patient, minus
amount owed by patient as their share of payment.
Volunteer staff (including AmeriCorps/HealthCorps, but not National Health Service Corps) who
description provide services on behalf of the grantee where there is a basis for determining their hours can
be included in the UDS report.
Providers (Column A) are counted if the service is provided on site at grantees clinic. Hours
volunteered are used to calculate FTE as with any other part time provider, however because
volunteers are not paid the denominator in the equation to calculate FTEs is the number of
Services provided by
hours that a comparable employee spends performing their job. This means, most specifically,
a volunteer provider
that a full time of 2080 hours (for example) will be reduced by vacation, sick leave, holidays and
5
(Service are not paid for
continuing education normally provided to employees. As a rule, the equation will be hours
by grantee!)
worked divided by a number somewhere around 1800. Providers are not counted if their
services are provided at their own offices.
Visits (Column B) are counted only if the service is provided at a site in the grantee’s scope of
service and under the grantee’s control.
6
Grantee counts primary diagnosis and/or services provided on site, as applicable.
If the provider is on-site, the charges for their services are treated exactly the same as for staff.
9D
Do not include charges for volunteer providers who are off-site.
October xx, 2010
95
ISSUE
Interns and Residents
WIC
October xx, 2010
DRAFT
TABLES
AFFECTED
TREATMENT
Health Centers often make use of individuals who are in training, referred to variously as interns
or residents, depending on their field and their licensing. Medical Residents and some mental
description
health interns are generally licensed practitioners who are training for a higher level of
certification or licensing,
Column A: Residents are counted in the category of credentialing that the provider is working
toward. Thus, a family practice resident is shown on line 1 as Family Physician, etc.
Depending on the arrangement, FTEs may be calculated like any other employee (if they are
being paid by the grantee) or like a volunteer (if they are not being paid). See volunteer
Table 5
providers, immediately above.
Column B: Visits between a medical resident and a patient are recorded as visits to that
resident or intern. Under no circumstances are the visits credited to the supervisor of the
resident of intern. Visits of a licensed mental health provider will be counted on lines 20a, 20a1,
20a2 or 20b. if the provider is not licensed, they will be counted on line 20c.
If the intern or resident is paid by the grantee or their cost is being paid through a contract
which pays a third party for the interns or residents, the cost is shown in column a on the
appropriate line (line 1 for medical, line 5 for dental, etc.) If the intern or resident is not being
Table 8A
paid by the grantee and the grantee is not paying a third party, then the value of the donated
time is reported on line 17. Be sure to describe the nature of the donation on the table at this
line.
Clients whose only contact with the grantee is for WIC services and who do not receive another
form of service counted on Table 5 from providers outside of the WIC program are not counted
3A, 3B, 4
as patients on any of these tables. Do not count as patients because of health education or
enabling services provided by WIC.
Staff (Column A) are counted on line 29a.
5
Visits and patients (Columns B and C) are never reported unless otherwise justified.
Column A: Net costs.
Total cost of program reported on line 12 in column a.
8A
Column B: Overhead.
Since much of the administrative cost of the program will be
included in the direct costs, it is presumed that overhead will be at a significantly lower rate.
9D
Nothing associated with the WIC program is to be reported on this table.
Income for WIC programs, though originally federal, comes to grantees from the State. Unless
9E
the grantee is a state government, the grant/contract funds received are reported on line 6.
96
ISSUE
DRAFT
TABLES
AFFECTED
5
In-house pharmacy or
dispensary services
for grantee’s patients
(including only that part
of pharmacy that is paid
for by the grantee and
dispensed by in-house
staff.)
[see below for other
situations].
8A
9D
9E
October xx, 2010
TREATMENT
Column A: Staff.
Pharmacy staff are normally reported on line 23. To the extent that the
pharmacy staff have an incidental responsibility to provide assistance in enrolling patients in
Pharmaceutical Assistance Programs, they are included on line 23. Staff (generally not
including pharmacists) who spend a readily identifiable portion of their time with PAP programs
should be counted on line 27a, Eligibility Assistance.
Column B: Visits.
The UDS does not require the counting or reporting of visits with
pharmacy whether it is for filling prescriptions or associated education or other patient / provider
support.
Line 8b, Column A: Pharmaceutical Direct Costs.
The actual cost of drugs purchased by
the pharmacy is placed on line 8b. The value of donated drugs is not reported here. They are
reported on line 18 in column c.)
Line 8a, column A: Other Pharmacy Direct Costs.
All other operating costs of the
pharmacy are shown on line 8a. Include salaries, benefits, pharmacy computers, supplies, etc.
Line 11, column A: Enabling Direct Costs.
Show the staff and other costs of staff (fulltime, part-time or allocated time) spent assisting patients to become eligible for PAPs.
Column B: Facility and Administration.
All overhead costs associated with line 8a and 8b
are reported on line 8a. While there may be some overhead cost associated with the actual
purchase of the drugs, these costs are generally minimal when compared to the total cost of the
drugs.
Column C, Line 18: Show the value of donated drugs (generally calculated at 340(b) rates)
here only.
Charge (Column A) is grantee’s full retail charge for the drugs dispensed.
Collection (Column B) is the amount received from patients or insurance companies.
Allowance (column D) is amount disallowed by a third party for the charge (if on lines 1 – 12)
Sliding Discount (column E) is amount written off for eligible patients per agency policies (line
13). Calculated as retail charge minus amount collected from patient, minus amount owed by
patient as their share of payment.
The value of donated drugs is not reported on this table – it is reported on Table 8A. (See
above)
97
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TREATMENT
Many CHCs which own licensed pharmacies also provide services to members of the
community at large who are not CHC patients. Careful records are required to be kept at these
pharmacies to ensure that drugs purchased under section 340(b) provisions are not dispensed
description to patients. Some of these pharmacies are totally in-scope, while others have their “public”
portion out of scope. If the public aspect is “out of scope”, none of its activities are reported on
In-house pharmacy for
the UDS. If it is in scope, the public portion should be considered an “other activity” and treated
community
as follows:
(i.e., for non-patients)
Column A: Staff.
Report allocated public portion of staff on line 29a: Other Programs and
5
Services.
8A
Report all related costs, including cost of pharmaceuticals, on line 12: Other Related Services.
Report all income from public pharmacy on line 10: Other, and specify that it is from “Public
9E
Pharmacy.”
Contract Pharmacy
5
No staff, visits or patients are reported. PAP staff all go to enabling services.
Dispensing to clinic
patients, generally
using 340(b)
purchased drugs
8A
October xx, 2010
If the pharmacy is charging one amount for “managing” the program and/or an amount for
“dispensing” the drugs; and another amount for the drugs themselves, the former charge is
reported on line 8a, the latter on line 8b.
If the CHC is purchasing the drugs directly [because of 340(b) regulations] the amount it spends
on purchasing goes on line 8b, and any administrative or dispensing costs charged by the
pharmacy go on line 8a.
If the pharmacy is reporting a flat amount for services including both pharmaceuticals and their
services, and there is no reasonable way to separate the amounts report all costs on line 8b.
Associated administrative costs will go on line 8a in column B, even though line 8a column A is
blank.
If prepackaged drugs are being purchased, and there is no reasonable way to separate the
pharmaceutical costs from the dispensing / administrative costs report all costs on line 8b.
Associated administrative costs will go on line 8a in column B, even though line 8a column A is
blank.
98
ISSUE
Donated Drugs
Clinical dispensing of
drugs
October xx, 2010
DRAFT
TABLES
AFFECTED
TREATMENT
Charge (Column A) is grantee’s full retail charge for the drugs dispensed or the amount
charged by the pharmacy / pre-packager if retail is not known.
Collection (Column B) is the amount received from patients or insurance companies or, under
certain circumstances, the pharmacy. (Note: most CHCs have this arrangement only for their
9D
uninsured patients.)
Allowance (column D) is amount disallowed by a third party for the charge (if on lines 1 – 12)
Sliding Discount (column E) is amount written off for eligible patients per agency policies (line
13). Calculated as retail charge (or pharmacy charge) minus amount collected from patient (by
pharmacy or CHC), minus amount owed by patient as their share of payment.
9E
No income would be reported on Table 9E.
If the drugs are donated to the CHC and then dispensed to patients show their value [generally
calculated at 340(b) rates] on line 18, column C.
If the drugs are donated directly to the
8A
patient grantee is not required to report the value of the drugs however it is preferred that the
value be included for a better understanding of the program.
If a dispensing fee is charged to the patient, show this amount (only) and its collection / write9D
off.
9E
Do not show any amount, even though GAAP might suggest another treatment for the value.
Many pharmaceuticals, ranging from vaccines to allergy shots to family planning shots or pills,
are dispensed in the clinic area of the CHC. This dispensing is often considered to be a service
description attendant to the visit where it was ordered or, in the case of vaccinations, to be a community
service. In most instances it is appropriate to charge for these services, though they are not
considered to be visits.
If this is the only service the individual has received during the year, they are not counted as
3A/3B/4
patients.
5
These services are not counted as separate visits.
6
Because these are not visits, they are not counted on Table 6.
Costs are reported on line 8b – pharmaceuticals (not on line 3, other medical costs.) In the
8A
case of vaccines obtained at no cost through Vaccines For Children or other state or local
programs, the value must be reported on line 18 – donated services and supplies.
Full charges, collections, allowances and discounts are reported as appropriate. Note that it is
not appropriate to charge for a pharmaceutical that has been donated, though an administration
9D
and/or dispensing fee is appropriate. Note that Medicare has separate flu vaccine rules.
99
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TREATMENT
9E
Do not show any amount, even though GAAP might suggest another treatment for the value.
ADHC programs are often recognized by Medicare, Medicaid and certain other third party
payors. They involve caring for an infirm, frail elderly patient during the day to permit family
members to work, and to avoid the institutionalization of and preserve the health of the patient.
description
They are quite expensive and may involve extraordinary PMPM capitation payments, though
are thought to be cost effective compared to institutionalization. If patients are covered by both
Medicare and Medicaid treat as in Medi-Medi, below.
When a provider does a formal, separately billable, examination of a patient at the ADHC
Adult Day Health Care
facility, it is treated as any other medical visit. The nursing, observation, monitoring, and
(ADHC)
5
dispensing of medication services which are bundled together to form an ADHC service are not
counted as a visit for the purposes of reporting on this table. Staff are included on line 29a.
IF there are separate medical services being provided and billed separate from the ADHC
8A
charge the associated costs are on lines 1 – 1. All other costs are reported on line 12.
ADHC charges and collections are reported. Because of Medicaid FQHC procedures it is
9D
possible that there will also be significant positive or negative allowances. See also Medi-Medi
below.
Some individuals are eligible for both Medicare and Medicaid coverage. In this case, Medicare
description is primary and billed first. After Medicare pays its (usually FQHC) fee, the remainder is billed to
Medicaid which pays the difference based on policy which varies from state to state.
4
Patients are reported on line 9, Medicare. Do not report as Medicaid!
Medi-Medi
While
initially the entire charge shows as a Medicare charge, after Medicare makes its
Cross-Over
payment, the remaining amount is re-classified to Medicaid. This means that eventually the
9D
charges and collections will be the same, though for any given twelve month period the cash
positions will probably not net out. In most cases a significant portion of the total charge will
transfer to Medicaid where it will be received and/or written off as an allowance.
Some programs pay providers on a fee-for-service or fee-per visit basis under a contract which
Certain grant
may or may not also have a cap on total payments per year. They cover a very narrow range
supported clinical
description
of services. Breast and Cervical Cancer Control and Family Planning programs are the most
care programs:
common, but there are others.
BCCCP, Title X, etc.
These are not insurance programs. They pay for a service, but the patient is to be classified
(These are fee-for
4
according to their primary health insurance carrier. Most of these programs do not serve
service or fee-per-visit
insured patients, so most of the patients are reported on line 7 as uninsured.
October xx, 2010
100
ISSUE
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AFFECTED
TREATMENT
9D
While the patient is uninsured, there is an “other public” payor for the service. The clinic’s usual
and customary charge for the service is reported on line 7 in column A, and the payment is
reported in column B. Since the payment will almost always be different than the charge, the
difference is shown as an allowance in column D.
9E
The grant or contract is not shown on Table 9E. It is fully accounted for on Table 9D.
programs only.)
State or local safety
net programs
These are programs which pay for a wide range of clinical services for uninsured patients,
generally those under some income limit set by the program. They may pay based on a
description
negotiated fee-for-service, or fee-per-visit. They may also pay “cents on the dollar” based on a
cost report, in which case they are generally referred to as an “uncompensated care” program.
While patients may need to qualify for eligibility, these programs are not considered to be public
4
insurance. Patients served are almost always to be counted on line 7 as uninsured.
The charges are to be considered charges directly to the patient (reported on line 13, column
A). If the patient pays any co-payment, it is reported in column B. If they are responsible for a
9D
co-payment but do not pay it, it remains a receivable until it collected or is written off as a baddebt in column f. All the rest of the charge (or all of the charge if there is no co-payment) is
reported as a sliding discount in Column E.
9E
Workers
Compensation
4
9D
Tricare, Trigon,
Veterans
Administration, Public
Employees Insurance,
October xx, 2010
4
The total amount received during the calendar year is reported on line 6a.
Workers Compensation is a form of liability insurance for employers, not a health insurance for
employees. Patient’s whose bills are being paid by Workers Compensation should have a
related insurance that is what is reported on Table 4 (even if it is not being billed or cannot be
billed by the CHC.) In general, if they had an employer paid / work-place based health
insurance plan they would be reported on line 11. If they do not have any health insurance,
they are reported on line 7.
Charges, collections and allowances for Workers Compensation covered services are reported
on line 10.
While there are many individuals whose insurance premium is paid for by a government,
ranging from military and dependents to school teachers to congressmen and HRSA staff,
these are all considered to be private insurances. They are reported on line 11, not on line 10a.
101
ISSUE
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TREATMENT
etc.
9D
Charges, collections and allowances are reported on lines 10 – 12, not on lines 7 – 9.
Some CHCs have included in their scope of service a site in a school a workplace, a jail, or
some other location where they are contracted to provide services to (students / employees /
description inmates / etc.) at a flat rate per session or other similar rate which is not based on the volume of
work performed. The agreement generally stipulates whether and under what circumstances
the clinic may bill third parties.
Contract sites
(In-scope sites in
schools, workplaces,
jails, etc.)
October xx, 2010
4
Lines 1-6 – income:
In general, income should be obtained from the patients. In prisons, it
may be assumed that all are below poverty (line 1). In schools, income should be that of the
parent or unknown or, in the case of minor consent services, below poverty. In the workplace,
income is the patient’s family income or, if not known, “unknown” (Line 5).
Lines 7-12 – insurance:
Record the actual form of insurance the patient has. Do not
consider the agency with whom the clinic is contracted to be an insurer. (Schools and jails are
not “other public” insurance.)
5
Count all visits as appropriate. Do not reduce or reclassify FTEs for travel time.
8A
Costs will generally be considered as medical (lines 1-3) unless other services (mental health,
case management, etc) are being provided. Do not report on line 12—“other related services”
9D
Unless the visit is being charged to a third party such as Medicaid the clinic’s usual and
customary charges will appear on line 10, column A. The amount paid by the contractor is
shown in column B. The difference (positive or negative) is reported in column D.
9E
Contract revenue is not reported on Table 9E.
102
ISSUE
CHIP
(CHIP-RA)
Carve-outs
Incarcerated Patients
October xx, 2010
DRAFT
TABLES
AFFECTED
TREATMENT
Medicaid:
If CHIP is handled through Medicaid and the enrollees are identifiable, they are
reported on line 8b. If it is not possible to differentiate CHIP from regular Medicaid, the
enrollees are reported on line 8a with all other Medicaid patients.
4
Non-Medicaid:
CHIP enrollees in states which do not use Medicaid are reported as “Other
Public CHIP” on line 10b. Note that, even if the plan is administered through a commercial
insurance plan, the enrollees are not reported on line 11.
Medicaid:
Report on lines 1 – 3 as appropriate.
9D
Non-Medicaid:
Report on lines 7 – 9 as appropriate. Do not report on lines 10 – 12 even if
the plan is administered by a commercial insurance company.
Relevant to capitated managed care only.
Grantee has a capitated contract with an HMO
which stipulates that one set of CPT codes will be covered by the capitation regardless of how
often the service is accessed, and another set of codes (or all other codes) the HMO will pay for
description
on a fee-for-service basis whenever it is appropriate. Most common carve-outs involve lab,
radiology and pharmacy, but specific specialty care or diagnoses (e.g., perinatal care) may also
be carved out.
Lines 2a/b, 5a/b, 8a/b, 11a/b.
Capitation payments are reported on the “a” lines, carve out
9D
payments are reported on the “b” lines.
Some grantees contract with jails and prisons to provide health services to inmates. These
description arrangements can vary in terms of the contractual arrangement and location for providing
health services to patients.
Income must be presumed to be below poverty.
Individuals receiving health services under this contract are not considered to have insurance.
4
The patient must be classified according to their primary health insurance carrier regardless of
whether the services will be billed to the insurer, but are almost always uninsured.
The patient’s services are paid for by the jail/prison. The clinic’s usual and customary charge
for the service is reported on line 10 in column A, and the payment is reported in column B.
9D
Since the payment will almost always be different than the charge, the difference is shown as
an allowance in column D.
9E
The grant or contract is not shown on Table 9E. It is fully accounted for on Table 9D.
103
ISSUE
(Migrant) Vouchers
October xx, 2010
DRAFT
TABLES
AFFECTED
TREATMENT
Voucher Programs have traditionally been an exclusive part of the Migrant and Seasonal
Farmworker program, though in recent years some Homeless and even CHC programs have
made use of the mechanism. In this system, the center identifies services that are needed by
description its patients which cannot be provided by their in-house staff. Vouchers are written to authorize
a third party provider to deliver the services, and voucher is returned to the grantee for
payment. Payment is generally at less than the providers full fee, but is consistent with other
payors such as Medicaid.
Patients are counted even if the only service that they receive is a paid vouchered service,
provided that these services would make the patient eligible for inclusion if the Center provided
3a, 3b, 4
them. Thus a vouchered taxi ride would not make the patient “countable” because
transportation services are not counted on Table 5.
Column A:
There is no way to account for the time of the voucher providers. As a result,
zero FTEs are reported with regard to these services. If there is a provider who works at the
center, the FTE of that provider is counted. For example, the one-day-a-week family
practitioner would be reported as 0.20 FTEs on line 1. But the 125 vouchered visits to FPs
5
would not result in an additional count on line 1.
Column B:
Count all visits that are paid for by voucher. DO NOT count visits where the
referral is to a provider who is not paid in full for the service (i.e., a “voucher” to a doctor who
donates five visits per week does NOT generate a visit that is counted on Table 5.
Diagnoses / Services.
The Voucher program is expected to receive from the provider a bill
6
similar to a HCFA-1500 which lists the services and diagnoses. These are to be tracked by the
center and reported on Table 6.
Cost of Vouchered Services.
The costs are reported on the appropriate line. Medical
vouchers are reported on Line 1, not Line 3. Report only those costs paid directly by the
grantee.
8A
Discounts.
Virtually all clinical providers are paid less than their full fee. Some grantees like
to report the amount of these discounts as “donated services”. While this is not required,
grantees may report the difference between the voucher provider’s full fee and the contracted
voucher payment as a donated service on line 18, column D.
104
ISSUE
October xx, 2010
DRAFT
TABLES
AFFECTED
TREATMENT
9D
Column A: Charges.
Report the full charge that the provider shows on their HCFA-1500 as
the charge on line 13 – self pay. Do not use the voucher amount as the full charge.
Column B: Collections.
If the patient paid the voucher program a nominal or other fee,
show this in column B.
Column E: Sliding Discounts.
Show the difference between the full charge and the
amount that the patient was supposed to pay in Column E. Do not show the full amount in
Column E if the patient was supposed to make a payment to the center and failed to do so.
Column F: Bad Debt.
Show any amount (such as a nominal fee) that the patient was
supposed to pay but failed to pay. Bad debts are recognized consistent with the center’s
financial policies. Amounts not paid may be considered a bad debt in 30 days or in a year –
whatever is the center’s policy.
105
APPENDIX C: SAMPLING METHODODOLOGY FOR MANUAL CHART
REVIEWS
DRAFT
INTRODUCTION
For each measure, health centers have the option of reporting on their entire patient population as a
universe. To report on the universe, the data source such as an Electronic Health Record must include
all medical patients from all service delivery sites and grant funded programs (e.g., CHC, HCH, MHC,
PH) in the defined universe. In addition, the data source must cover the period of time to be reviewed
(e.g., three years for pap tests, etc.) and include information to assess compliance with the clinical
measure as well as to evaluate exclusions. Reporting on the universe is more accurate (i.e., it reports
on 100% of patients) and easier (i.e., queries are automated). In practice we have observed more
errors from universal queries of EHRs than from samples. Although optimal, there is no requirement
that health centers report the universe. Indeed, BPHC has no preference for reporting the universe or
a sample.
If the health center cannot report on the universe (or chooses not to), a random sample will be used to
report. Note that the health center can report on the universe for some measures while using a
sample to report others. It is not necessary that all measures be reported using the same method.
The following measures can be reported using a sample:
•
•
•
•
Table 6B Childhood Immunization Rate – percent of patients 2 years of age with up-to-date
immunizations.
Table 6B PAP Test Rate – percent of female patients aged 24 – 64 who have had a PAP test
during the measurement year or during the previous two calendar years.
Table 7 Controlled Diabetes – Percent of 18-75 years of age diabetic patients with HbA1c
levels ≤ 9%.
Table 7 Controlled Hypertension – percent of patients 18-85 years of age with hypertension
whose latest blood pressure was less than 140/90.
Table 6B and 7 prenatal indicators cannot be reported using a sample.
RANDOM SAMPLE
A random sample is defined as a part of a universe where each member of the universe has the exact
same chance of being selected as every other member of the universe.
Thus, a true random sample will generate outcomes which are similar to outcomes reported for
the universe of patients because the sample is “representative” of the universe.
October xx, 2010
1061
DRAFT
STEP BY STEP PROCESS FOR REPORTING CLINICAL MEASURES
For each measure, perform each of the following steps.
STEP 1: Identify the patient population to be sampled (the universe):
Define the universe for each condition.
• Including all active (measurement year) medical patients
• Including all sites in the scope of project
• Including contracted medical services
Identify the number of patients who fit, or who initially appear to fit, the criteria for that
measure. Create a list and number each member of the patient population in the
universe.
STEP 2: Determine the sample size for manual chart review:
The number of charts selected for manual chart review will be the lesser of 70 charts or
all patients who meet the criteria.
STEP 3: Select the random sample
Using one of the two recommended sampling methodologies, identify the sample of 70
charts (assuming the universe is greater than 70, otherwise report on all patients).
STEP 4: Review the sample of records to determine compliance with the clinical
measure.
For each measure, review available data sources to identify any automated sources to
simplify data collection. Since these data sources will be augmented by the paper
record, they do not need to include all patients from all service sites and programs.
Examples of data sources include:
• Electronic health record
• PECs database
• State immunization registries for vaccine histories
• Logs
• Practice management system
For each patient in the sample, determine whether sufficient information is available in
available data source(s) to confirm compliance. If compliance cannot be confirmed
from the alternative source, pull the paper record to retrieve required information.
STEP 5: Replacing patients that should be excluded from the sample.
If a patient is selected that should be excluded from the sample, the patient will be
replaced with a substitute. Use the replacement methodology described for the
sampling methodology selected. Exclusions are as follows:
• Childhood immunizations – none
• Pap tests – women who have had a hysterectomy
• Controlled hypertension – none
• Controlled diabetes - patients with a diagnosis of polycystic ovaries that do not have
two face-to-face visits with the diagnosis of diabetes, in any setting, during the
measurement year or year prior to the measurement year; gestational diabetes
(ICD-9-CM Code 648.8); or steroid-induced diabetes (ICD-9-CM Code 962.0, 251.8)
during the measurement year.
Using this method, the final sample size to be reported on the UDS will be the lesser of
October xx, 2010
1071
70 charts or all patients who meet the criteria for each measure but never more than
70.
DRAFT
October xx, 2010
1081
METHODOLOGY FOR OBTAINING A RANDOM SAMPLE
DRAFT
Two methods are recommended for generating a random sample and replacements for excluded
patients:
•
Work with a list of random numbers generated for your total patient population.
•
Select a random starting point and use a calculated interval to find each next member of
the sample.
Either method can be used to create a “replacement list” used to replace patients who are excluded.
Option #1: Random Number List
A list of random numbers can be created at the web site: http://www.randomizer.org/form.htm
The web site requires no password or subscription to access. To obtain a list of random numbers,
complete the questions as documented below. Complete the “Number Range” by entering the
maximum number of patients in the universe for the particular measure under consideration as “n”.
For example, if there are 700 children who turn two in the reporting year in the universe, enter 700 as
the maximum range.
Then press the button “Randomize Now!” A list of randomly generated numbers will be created.
These numbers correspond with the numbered list of patients in the universe prepared in Step 1,
above.
October xx, 2010
1091
DRAFT
Identifying a replacement:
To create a “sample” of patients to substitute for patients who should be excluded from the sample,
follow the instructions for creating a list of random numbers for a replacement sample. Rather than
selecting 70 numbers for the set, select a small sample of 5 to 10 charts. If a patient should be
excluded from the original random sample of 70, replace that patient with one of the patients from the
replacement sample. In this manner, more than 70 patients may be evaluated for compliance for a
particular measure but the final sample will include 70 patients who meet all the selection criteria.
Option #2: Interval
A second method uses the same numbered list of patients in the universe created in Step 1, above.
To generate the sample:
1. Calculate sampling interval by dividing number of patients in the universe by 70:
Sample Interval Size (S1) = Population size (number in universe)/ Sample size (70)
2. Randomly pick a patient from the first sampling interval. For example, if the sampling interval is
10, the first sampling interval includes patients no.1 through no.10. Randomly select one
patient from this interval.
3. That will be your first record sequence number
4. Then, select every nth patient based on the sampling interval until you reach the desired
sample size. In our example, if the first patient selected is number 8, and the sampling interval
is 10, then the remaining patients to be selected are no.18, 28, 38, etc.
first sequence # + SI = second #
5. Continue through list until all 70 have been identified
October xx, 2010
1101
DRAFT
Interval Method: Example
1
951456
Sample Interval (SI) = 3
Identifying a
replacement:
If a selected patient should
be excluded from the
First record = #2
4
157614
sample, return to the
(selected at random
5
736812
original list and substitute
from between 1 and 3)
6
453764
the excluded patient by the
7
416145
next patient on the list. If
8
801784
that patient should be
Next records = #5 (2+3)
9
481454
excluded select the next
10
487151
#8 (5+3)
patient on the list until an
11
158124
eligible patient is selected.
#11 (8+3)
12
484504
Resume selection using
13
789415
the next chart you had pre#14 11+3)
14
781763
selected for the sample. (If
15
745485
you run out of patients,
93
continue your count back at
the beginning of the universe). In this manner, more than 70 patients may be evaluated for
compliance for a particular measure but the final sample will include 70 patients who meet all the
selection criteria.
2
234951
3
492374
October xx, 2010
1111
| File Type | application/pdf |
| File Title | BPHC UDS Manual-- 2011 |
| Author | Arthur Stickgold + Suz + JSI Staff |
| File Modified | 2010-10-25 |
| File Created | 2010-10-22 |